Friday, April 7, 2017

April 7, 2017 Legislative Update

Legislative Update
Rep. Anne Donahue
April 7, 2017

It’s the calm before the storm. The House has passed the budget and sent it to the Senate, and we’re back in committees reviewing bills from the Senate, with little action on the House floor. Within the next few weeks, anything significant for this year will start seeing a lot of action, because once the Senate sends the budget back, the clock starts ticking for the end of the session.
Senate Health Care Bills
Our committee is reviewing 7 bills passed by the Senate, and we will not get to all of them this year, so we are identifying priorities. Others can still be taken up in the second half of the biennium in January.
On the top of the priority list is S.133, “An act relating to examining mental health care and care coordination,” which is reviewing the public mental health system in Vermont. My first reaction is that it calls for too much study, and not enough action, given the crisis we are confronting as a state. We have testimony scheduled for much of next week.
We will also be hearing testimony next week on a bill that would mandate standards for circulating nurses in hospital operating rooms. I’m concerned that we may be micro-managing the medical profession if we step into this one.
We will likely act favorably on a Senate proposal that requires open meetings (and sets some parameters) for the governing bodies of accountable care organizations.
We are also close to finishing work on a proposal for health insurance coverage of services provided via telemedicine. It’s all part of our brave new world in health care, and holds out promise for increasing access to care in a rural state like ours, as well as reducing some costs. But is it really the same as, for example, seeing a therapist face-to-face?
We are a bit leery, and so are adding an informed consent requirement that lets patients know what might differ in telemedicine service delivery, and that they can discontinue it at any time if they are uncomfortable.
Vermont passed the nation’s most aggressive law some 10 years or so ago to block pharmaceutical companies from buying access to medical professionals through meals or other gifts, including at conferences. The pharma companies have fought back by denying Vermont doctors access to conference lunches and dinners – instead of letting them simply pay their own way.
So the Senate has passed a bill that would once again allow for that proverbial “free lunch.” It’s supported by the Vermont Medical Society, but we’ve been getting a lot of emails from doctors saying they are proud of Vermont’s standards.
I find it a bit of a double standard when we legislators gather around for the free munchies being offered in the cafeteria by one interest group or another, but think doctors can’t withstand influence from drug companies. On the other hand, big Pharma is probably more invidious in its intentions than the Alzheimer’s Association (free ice cream this week) or the Bar Association (wine and cheese) that want to bend our ears.
The final bill from the Senate is a bill for generic substitution of what are called, “biological products.” Most drugs consist of pure chemical substances, while biological products are made from a variety of natural sources (human, animal or microorganism) and replicate natural substances such as enzymes, antibodies, or hormones in our bodies.
This newly expanding form of drug therapy is very expensive, and interchangeable versions are expected to be coming to the market soon. This bill would require pharmacy substitution of “interchangeable biologics” in the same way that generic substitutions now occur, in other words, unless otherwise directed by your doctor.
Worker’s Compensation
A bill related to worker’s compensation voted out by our committee unanimously weeks ago has finally emerged from the House Commerce Committee on a 9-1-1 vote after lengthy discussion and debate. (A bill that comes under the subject jurisdiction of more than one committee must be reviewed by each such committee.)
It would establish two things:
-          That a mental condition that is directly caused by a work event is covered by worker’s comp in the same way other injuries or work-related diseases are (in other words, parity); and
-          That in the case of emergency first responders who experience post traumatic stress disorder, a presumption would exist that it was caused by the work event, unless proved to the contrary.
It’s amazing to me that it’s taken almost 20 years since first passing our health insurance parity bill for mental health we are finally recognizing that worker’s comp, as well, needs to treat equally all health conditions that are caused on the job.
The argument against this new bill has been that it will raise worker’s comp insurance rates – the same argument made against the parity bill in 1998, and soundly disproven.
I will never forget when I first discovered in 1996 that because I made the mistake of “choosing” the wrong illness, my hospitalization for major depression wasn’t covered by the health insurance I was paying for.
I testified at a legislative hearing that next year in support of the parity bill. It was the first time I had ever entered the State House, and it was the beginning of the trajectory in advocacy work that has led me to a place on the State House floor. I will be proud to speak here in support of parity, once again.

Thank you for the honor of representing you. Please contact me with your questions and your opinions. You can reach me by message at home at 485-6431, at the statehouse at 828-2228, or at this email at

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