For starters, a reminder: almost none of
the news you hear early in the legislative session is actually the final word
on a topic. Interesting bills that make good headlines won’t necessarily even
be taken up in a committee. Proposals, even from leadership folks or the
governor’s office, are still just that… proposals. Even if they move forward,
it will likely be in a very changed form. For major subjects (education reform,
as one example), the various proposals are a part of a discussion that will
likely not be resolved – if at all – until the session nears its end in early
May.
***
Sanctity of a Vote
One topic did reach finality this past
week. Under the constitution, only the legislature has the authority to
determine validity of a member’s qualification, so our House vote to validate
the House member from the Bennington-1 district was final.
There was a serious foul-up. About 50 or
so voters (literally on the “wrong side of the street”) received ballots for a
different district, in error. It was a close election, so those votes could
have made a difference. Clearly, there were voters who were denied their right
to vote for their state representative. The problem was the inability to create
a solution that would not deny others in the district their right to vote,
because of unavoidable byproducts of attempting to hold a new, special
election. The sanctity of each vote is crucial, but two wrongs can’t make a
right. I voted to keep the status quo; the overall vote was 91-42. There is now
a plan to develop a law that will directly address issues like these.
***
Budget Adjustment
We also voted on the mid-year adjustment
of last year’s budget. It now goes to the Senate for consideration. In theory,
this annual bill permits shifting money from areas of underspending into those
that had shortfalls. This year, higher than expected revenues provided greater
leeway to add funding where needed. But anything spent now cuts into meeting
new goals for the year ahead.
There ended up being only one area of
dispute. The House is proposing to backpedal on its compromise with the Senate
from last year regarding putting restrictions on the emergency motel program
for homeless Vermonters. Those eligible for a room are primarily households
with a child under 19, age 65 or older, or with a disability, and who lack
adequate housing, when there is no shelter space available. Under the current
budget, an 80-day annual limit for access to a motel voucher does not apply
during a “winter housing” exemption that ends on March 31.
Last fall, some households lost coverage for
exceeding 80 days during the time before the winter exemption started, and
Vermonters watched with concern as some ended up without shelter during that
time. The revision proposes that the current winter exemption be extended
through the end of the budget year (June 30) so that no one would lose shelter
while we continue to try to agree on longer-term solutions. Surely, we did not
want to repeat last year’s crisis when we reach April 1?
As I tried to articulate on the House
floor, this misconstrues the nature of the dilemma. We cannot create motel
rooms that don’t exist. As a result, some of these eligible households are
currently still being turned away for lack of capacity even though they are eligible
within the current rules. Being eligible as “homeless” is defined as not having
an “adequate” place to live. It includes, for example, families who have to
double up and those without a stable address. “Unsheltered homelessness” means
the subset of those who are homeless who have no place to spend the night that
is considered fit for human habitation.
The current rules make no distinction, so
there is no priority for those who are completely without shelter. If those
already in a motel can now remain longer, there will be more of those who are
newly homeless – including those with no shelter at all -- left out, because of
lack of capacity. Extending the “winter exemption” so that there is no cap on
the length of stay does not increase motel capacity or ensure shelter. It only
creates a priority for those who are already there.
Members made statements of compassion on
the House floor that ignored that impact altogether: “I voted yes because every
child we fail today is a lost opportunity for Vermont’s future;” “If we look
outside, we see weather no one should be unhoused in. With climate chaos, harsh
weather is possible anytime of year;” and, “There are many issues involving
homelessness that this body must solve, in the long term. Kicking people into
the cold solves none of them and would cost lives, in the short term.”
I explained my vote against the change in
the bill, stating, “Extending the length of stay for some people, resulting in
cutting off access to shelter for others, is not the right way to support those
most in need. It actually turns our backs on them.” The overall bill passed,
87-51, and is now in the Senate’s hands.
The bill that will attempt to develop a
longer-term solution is currently under review in my Human Services committee.
Whatever it ends up proposing, however, won’t take effect until July of 2026,
which means the struggle over interim funding and motel use will continue for
the budget that begins this July. The governor’s proposed budget includes $30
million in motel vouchers, which extends the current program but it does not re-expand
it to the new budget adjustment bill proposal.
I strongly believe our focus is both far
too broad and far too narrow. We want to do optimal things, even when it leaves
many people at highest risk behind. I think we should always do everything
possible to provide a roof over the head over those who have none, who are
unsheltered. Right now, we only do that – even under the “winter exemption” –
for those in the defined “vulnerable population.” But that roof may not mean
private hotel rooms and should not give priority to those who do have other
options, even if they are not optimal.
***
Establishing Fair Payment
The governor’s budget presented in January
noted the significant costs in simply “keeping the lights on” for existing
government programs. Inflationary pressures, including health care costs, mean
it costs more to maintain the same services. Thus, he said, there will not be
much to spare even with our improved revenues. He hopes to use some to reduce
any increase in property taxes while reforms in education spending roll out.
This recognizes the fact that if something
is level-funded as costs rise, the service is actually cut. That is the reality
of portions of the proposed budget, however, because the many government
services that are funded through payment rates or grants to private, non-profit
agencies are not receiving any increases to offset cost pressures. That includes
community mental health agencies and the home- and community-based services
provided by home health care, as examples. Every year, we hear from advocates
for these services begging for sustainable funding that would maintain their
work. We have to react based upon trying to assess disparate needs and to
balance the budget.
This year, my committee is working on a
bill that would create a more objective standard for assessing budget needs. It
would require the Agency of Human Services to do regular Medicaid rate payment
reviews using objective standards that result in rates that are “reasonable and
adequate to achieve the required outcomes,” including a cost adjustment factor to
reflect inflation and labor market dynamics. That would not mean those would be
the actual payment rates that ended up in the state budget. What it would do
would be to level the playing field in assessing what we can and cannot afford.
If we can’t afford it, we need to acknowledge it, not pretend we are paying for
it. In many areas, we currently have no objective way of telling whether we are
paying 50 or 75 or 90% of what full funding would be. Budget choices end up
being inequitably-informed choices.
The Agency itself has testified in support
of the proposed new requirement for regular rate reviews, though it was not quite
willing to acknowledge that we currently are operating on a double standard in
what we pay for state-run services versus those funded by state rates. It is a myth
to tell ourselves that we are actually providing a service if the
service-provider isn’t being paid enough to do the job and has to cut what it
is providing.
The issue of Medicaid underpayment is
better known in the realm of hospital care, and that is coming to the forefront
in its own way. Historically, hospitals make up the difference through
“cost-shifting” and using higher private insurance rates to make up the
deficit. Our increasing insurance premiums reflect the increases in costs being
charged for the services, but also, in effect, include a “surcharge” for
covering government underpayment.
It can result in perverse outcomes. For
example, inpatient psychiatric care is one of the few services that private
insurance underpays for, part of historic bias and lack of parity in mental
health care. Hospitals therefore can’t cost-shift, and they lose money. That’s
why Central Vermont Medical Center eliminated inpatient psychiatry altogether
at the end of January. Faced with a need to cut the level of growth in its
budget, it cut the money-loser – a straightforward financial decision,
irrespective of any balancing of impacts on the health of its patient
population.
Unsustainable health care costs are high
on the legislative agenda this year, but where those conversations will go is
hard to predict. There is finger-pointing in all directions, despite an urgent
need to put heads together collaboratively.
***
Please keep in contact to share your
opinions and concerns; Rep. Ken Goslant and I both welcome your input. You can
reach us at adonahue@leg.state.vt.us and kgoslant@leg.state.vt.us. A full archive
of my legislative updates can be found at
representativeannedonahue.blogspot.com
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