May 20, 2017 Legislative Update

House members were called in on scattered days for brief spurts of action on the floor over the past two weeks before adjournment, mostly waiting for news that there was actually a budget to be voted on. The rank-and-file were never really privy to the efforts to resolve the teacher’s health insurance negotiation issue, but were on stand-by for whether Education Fund language would, or would not, be added to a bill.

There was so much focus on the $26 million that might be saved in the Education Fund that there was no attention at all to the actual budget. By the time we were hearing the conference committee report at about 11:30 p.m. Thursday, no one asked any questions.

Even I, who has acquired a reputation for being someone who actually reads every bill, did not rise to ask for clarifications on some of the “squishy” numbers that are part of the annual budget-balancing game. We were already two weeks past the targeted adjournment; people were anxious to have it come to an end, and I feared my head being bitten off.

It’s not as if we ever actually build an entire budget. Government lurches forward at an annual cost of (this current year) $5.75 billion, and we battle over the nickels and dimes (or less) that represent the changes from the prior year. In fact, the entire difference in negotiating between the House and Senate version of next year’s $5.82 billion budget was $14.5 million, settled with a reduction of $4.9 million. Literally pennies, within the overall scope.

But it is part of a much big picture of how we juggle money in the budget, not because a specific nickel here or nickel there impacts the budget on its own, but because, as they say, “after a while it adds up to real money.”

So it is with the teacher’s health insurance debate.

The potential $26 million in savings isn’t actually an amount to be worth the level of the fight over it, compared to the size of the Education Fund as a whole. But it is about a trajectory of spending, and about a principle: if there is a sound way to save real money, do we ignore it? Or do we recognize that every penny matters, and pursue it?

One of the “detail” issues on the teacher insurance question – and there are many, beneath the short sound bites -- is how it can be that we have new health plans that save $26 million, yet assure that the recipients get the same coverage than they do now. (Can I buy that plan, please?)

That’s a question I haven’t heard discussed very much, so here’s the basic explanation:

It goes back to the Affordable Care Act, and what was often referred to as the “Cadillac Tax.” When I first found out what that was, I actually though it was one of the few brilliant pieces of the ACA. What it recognized was the well-researched fact that one significant component of our high health care costs in the U.S. is over-utilization: we get care that we don’t need. And if enough of your health care is fully covered by insurance, you are more likely to over-utilize care. It is human nature. We feel we paid for it, so we have a right to use it.

So the ACA put an upper limit on what it called the “actuarial values” – the percentage of the average person’s costs that a plan covers – at 90 percent. Plans at higher values get a heavy tax placed on them, to discourage them. The current teacher’s plans run at about 96 percent.

The “grandfathering” for old Cadillac-level plans is now over, and teachers will be moving to plans that cover less, at a much lower premium price. (That is a fait accompli that has nothing to do with the controversy over who does the negotiating.)  This is a once-only moment in time for this changeover.

The total savings for the new plans across the state will be about $75 million, on an ongoing basis.

If all stays at status quo, each school board will have to figure out how to negotiate what happens to those savings within each district. Increased salaries to offset lower health insurance value? Reduce the local budget (which ends up helping the statewide Ed Fund, perhaps more than the local property taxpayer)? There are many options.

The proposal developed by the School Board Association and then endorsed by the Governor was to take $49 million of the $75 and put it back into teacher’s health care in the form of health savings accounts. That amount gives teachers the same as current levels of coverage, or even slightly better – in terms of co-pays, and so forth – but the education system as a whole saves the remaining $26 million.

How could that be, that $49 million buys a $75 million equivalence in coverage?

That’s the difference, on a very large scale, in the actual utilization rates when the payment is coming from a health savings account (where you keep the leftovers) versus an insurance company pocket.

But none of the numbers compute very well if they are being broken into different plan packages with different percentages of cost-sharing, district-by-district. If left individually negotiated, the odds aren’t good that the optimal savings will occur; they certainly won’t occur evenly across the state; and the savings might be invested in many ways other than reducing property taxes.

The School Boards and Superintendent’s proposal was to move the collective bargaining (move it, not end it) from local districts (local school boards) to a statewide contract, for health insurance purposes only. Other benefits would remain locally negotiated, but there would be a single health care plan that would be equitable across the state.

The need to do it on a statewide basis is where the “everyone wins” fell apart, with the teacher’s union taking the position that negotiating at the state level was taking away collective bargaining rights, because the state is not the direct employer. Collective bargaining, they are saying, is destroyed if it is not a direct employer-employee relationship, regardless of who is paying the bills. (As we are all painfully aware, the creation of a statewide Education Fund turned us into taxpayer-employers acting through the state, instead of acting locally, in collecting the money and paying the bills.)

Herein lies the irony of that position: I’ve been in the legislature long enough to have seen two different initiatives – both successful – to have the state pass a law to allow a union to form, among a group of workers, for the purpose of bargaining with the state-as-funder rather than with their actual employers.

Take the example of child care workers, employed by local daycare centers that receive a significant amount of funding through state subsidies for children attending the centers. They lobbied for and won the right to form a union for collective bargaining with the state for establishing the subsidy rates.

So I can’t buy the concept that having health care negotiated on a state-level basis is hurting the integrity of collective bargaining. We are the employers (represented by our school boards), but we are already, virtually speaking, state-level employers –far more so than the state role with day care workers.

The bottom line is that this is a “draw-a-line-in-the-sand” power struggle between a governor who wants to set a direction about affordability and maximizing savings for taxpayers, versus a union that wants to demonstrate its ability to control legislators votes, and exploiting its own members in the process.

I am opting to stand behind the governor. We’ll find out where it all ends sometime after the veto override vote on June 21.

***

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 or at this email at counterp@tds.net

Legislative Update on the Marijuana Vote

Legislative Update: Bill to Legalize Marijuana

May 12, 2017

 A lot has happened in just the few days since I originally wrote this draft to discuss my “no” vote on the marijuana legalization bill in the House. After the 75-71 vote to pass the bill, it went back to the Senate, which has consistently opposed the House approach. If our session had ended last week, as expected, the issue would have been left there, to be taken up next January.

Instead, the budget stalemate extended our session and we received a counter-proposal from the Senate which accepted our language but delayed implementation by a year (to July 1, 2018) and added a Commission to develop a proposal for January for the Senate’s much broader “tax and regulate” approach. That means that if the Senate can build support, its approach could replace the House’s, for implementation next July.

The House voted to support the Senate’s counter-proposal, so it now goes to the Governor’s desk, where he is mulling on his action. If he decides to veto it (which is not a clear outcome), we will likely be re-voting in June on whether to override the veto, which requires a two-thirds majority. Since the Senate proposal passed the House on a 79-66 vote, that means there would need to be roughly 15 members to change positions, for an override to occur.

My discussion explaining the position I ended up taking remains relevant, so I will pick up here with what I drafted to send out last week:

I could have accepted legalizing adult possession and cultivation of small amounts of marijuana, if we were aggressive with the stated premise that it would not harm others. My preference was to retain a small civil penalty for both using and growing – simply to avoid a public message of normalizing use of what still is, after all, a federal crime – but that approach was rejected on the first day of debate.

So were the sponsors serious about protecting children and protecting safety on our highways, given that legalization will undoubtedly end up creating some degree of increase in overall use?

I introduced a series of amendments targeting those issues.

First was to have the misdemeanor crime that was created for providing marijuana to minors include use in the presence of minors; in other words, providing it via second-hand smoke. I don’t think it’s OK to make it legal for adults to be using pot with their kids in the room. 

I also wanted to add it as grounds for a child abuse/neglect investigation if a parent provided marijuana to a child under age 16.

In terms of marijuana and driving on our highways: Given that there is no means for an immediate test that demonstrates a blood level for impaired driving, I think there is a need for some extra thresholds of protection .

I proposed three amendments on this issue. First was that allowing active smoking of pot by a passenger while a car is being driven should be banned in the same way as smoking pot by the driver (or drinking by the driver, which is a $500 fine in current law.)

Second was a fine for possession of marijuana in a motor vehicle unless in locked container. It’s a message about having a bright line: marijuana and driving don’t mix; it should not be easily accessible.

Third was allowing active use of marijuana in a car while driving to be used as one element of evidence in an impaired driving prosecution.

Finally, I wanted to see my rights better protected. The legalization for cultivation requires that it be on property that a person is “lawfully in possession” of, or with permission from the person with lawful possession. I proposed that it require written consent.

I also believe that legalization should be restricted to use on one’s own property (or with permission of the owner.) That was my final proposed amendment.

The major “push-back” on my proposals was that they violated the concept that we should treat pot in the same way that we treat tobacco and alcohol, which are seen as being as bad, or worse, than marijuana. To me, that is a bizarre concept. We have two substances that are addictive and harmful, so we should add a third and not add precautions?

There is also voluminous medical evidence of harms that go beyond alcohol or cigarettes, including, for example, the risk of bringing on psychosis.

We have also been working over some time to increase protections to others for tobacco and alcohol use, becoming much more aggressive about second hand smoke and about drunk driving, for example. Those experiences demonstrate how hard it is to push back on something that is already legal. It’s far better to start with more protection – and ease off if demonstrated to be not necessary.

That concept of “equal treatment” also ignores the reality – for better or worse – that marijuana is still illegal under federal law!

The most amazing responses to my proposals came from the Judiciary Committee.  A member of the committee – the committee that considered the bill for months – said that the committee agreed with my concern about protecting children, but needed to look for a better means to achieve it. “We’d like to find a way to do that,” he said. He concluded that, “If we pass the bill, we should come back to these issues”

What? Fix them after passing the bill? That’s totally backwards, and is not the way we deal with any other legislation.

My proposals to add protections for children were both rejected. The proposals for locking up pot when it’s in a motor vehicle, and for smoking in the car being admissible evidence when prosecuting for impaired driving, were rejected. Limiting use to one’s private property was rejected.

A final issue raised by others was the question of whether we had done due diligence on evaluating health impacts. Our MD member of the House strongly opposed the bill, and cited a major review of research by the National Academy of Sciences.

However the bill had never been reviewed by our Health Care Committee. A motion to send it there, also failed.

So I voted “no” on the bill as a whole. The very closeness of the vote – it passed by only four votes, 75-71 – was certainly an indication that I was not the only one with these concerns.

[As an addendum I would note that when the House bill we passed came back from the Senate, it was in its original form, so it did not include the two minor amendments I offered that were endorsed by the full House. Those were to ban driving a car while pot is being smoked by a passenger in the same way as smoking by the driver (or drinking by a driver), and to require that consent to grow pot on someone else’s property be in writing.]

May 6 2017 Legislative Update

In typical end-of-session fashion, we worked several nights until midnight last week and were prepared to meet Saturday. Then the Speaker surprised us Friday evening with the announcement that budget negotiations had reached a stalemate.

We will return next Wednesday to allow a “cooling off” period before trying to wrap up the last few days of work.  So instead of a session-end budget-and-tax-bill report, this update will follow up on some of the other issues that played out in the past week.

***

Pregnancy accommodations

I reported on my previous objections to the provisions in a House bill on work accommodations for pregnancy, based on the way it was drafted. I know that sometimes there is a perception that opposition to the way a bill is constructed is just an excuse to oppose it. So I’m happy to report that the Senate sent us the bill back in almost exactly the way I suggested the bill should be structured, and I voted fully in support. 

***

Family leave

I did hear back from a number of folks after expressing my uncertainty about the family leave proposal; the response was almost 2-to-1 in opposition. I proposed an amendment in support of establishing the program as an “opt-in” model to start.

If the report that 70 percent of Vermonters want this insurance is accurate, that would be enough participation to sustain it. However my amendment was rejected, so I voted against it the underlying bill, which mandates participation (and a payroll tax to fund it) for everyone.

The bill did pass but is now in the Senate, so there will be no action on it before next year. It amounts to roughly a $17 million new tax on Vermonters, which makes it likely that if a bill does eventually pass, the governor will veto it.

***

Marijuana

After many postponements, the House narrowly (74-68) passed a bill to legalize possession and use of an ounce or less of marijuana (currently it’s a $200 fine) and cultivation of several plants (currently illegal.)

The Senate has sent a bill to the House several times to establish a “tax and regulate” open market for marijuana, an approach the House has soundly rejected every time.

The House bill was so different, it would have died for this year if the session had ended on Saturday. But on Friday, the Senate offered a compromise that would adopt the House plan, and create a Commission to study the tax and regulate option. With the extra days next week, there may be time for the House to decide to accept this compromise.

My own vote was dependent upon some key amendments that failed to pass – thus I voted “no.” I will share a separate update with the details.

***

Forest fragmentation

This addition to Act 250 was problematic because it could add even more to the cumbersome and time-consuming process for getting development approvals in Vermont. (Most projects are eventually approved, but the administrative burdens are lengthy, expensive, and an economic development barrier.)

However, ensuring that our forestlands are protected is incredibly important, and can’t wait. I heard from several of you encouraging support, and none objecting, which helped influence my “yes” vote.

***

Toxic chemicals

On the other hand, as much as protection against toxic chemicals in children’s products is also critically important, this bill – after changes were made to the original Senate bill by the House – went way, way overboard, ditching the use of a science base as the criteria for placing substances on a “banned” list.

It also turned total control of these decisions to a single person, removing the requirement for recommendations by a panel of experts.

Paul Poirier, a liberal Independent from Barre, offered an amendment that retained that recommendation, but it was rejected. Without that, I could not support the House version of this bill.

***

Teacher’s health care coverage

I heard from more constituents on the issue of a statewide contract for teacher’s health insurance than on any other issue this year. The majority of messages were from teachers, and almost all of them were in opposition. Everyone else who contacted me, including our district superintendent, supported the change.

Although the money at stake is important ($26 million a year), there is more to it. It also involves equity for educators statewide for health coverage, and relieving volunteer school boards of the complexity of negotiating health coverage packages.

There seemed to be misinformation about an effect of eliminating teacher bargaining, which it would not do. Salaries and other benefits would remain the subject of local negotiations; health coverage would be under a statewide contract, but still a union negotiation issue.

We’ve long eliminated local control over spending by creating a statewide pool of funding that means even if our district saves on costs, our taxes go up when others around the state do not. This was a huge opportunity to make a step forward in long term improvement in how we address school funding issues.

The $26 million in savings were estimated after putting aside all the resources needed to ensure educators had fully equivalent coverage and cost-sharing to the excellent coverage they have currently.

The reason it is a single window of opportunity which will not repeat is because of the fact that all healthcare policies for schools are being re-negotiated right now, at the same time, as a side effect of the affordable care act. We can’t give it more thought and come back next year to act on it.

A number of Democrats “crossed the aisle” to join Republicans and Independents in support of this eminently logical, fair, and cost-savings measure. It actually passed by a single vote, but rules allow the House Speaker (who is also a representative, after all) to vote in case of a tie – or if a vote will create a tie. The Speaker exercised that option, creating a tie, meaning that it was rejected by the House.

What remains to be seen is the impact on the state budget negotiations.

The Senate passed a budget that increased spending over the House proposal, and shifted $8 million in costs onto the Education Fund (in other words, onto property taxes.) However, like the House, the Senate rejected seeking the $26 million in Ed Fund savings through a teacher’s health contract change.

The governor wants to see that savings happen, and is using the budget discussion as his leverage. Thus… the stalemate, and our delayed adjournment.

***

Thank you for the honor of representing you. Please contact me with your questions and your opinions. You can reach me by message at 485-6431or at this email at counterp@tds.net

April 21, 2017 Legislative Update

Legislative Update

Rep. Anne Donahue

April 21, 2017

Into the final two weeks: from fun, to mundane, to the “big ones.”

On Wednesday, I had the pleasure of joining with Governor Phil Scott and Rep. Patti Lewis in welcoming the Norwich Cadet hockey team, winners of the national Division III championship, to the statehouse.

The Governor read a proclamation congratulating the team, and Patti and I presented copies of the House resolution and a special resolution honoring Coach Mike McShane for his accomplishments, including this season’s 700^th win.

The players, in turn, presented Scott with a team shirt with his name on it – which he promptly put on.

***

Bathrooms

Don’t panic based on rumor. Vermont is not (yet) plunging into the battle over multiple-stall gender-neutral bathrooms. What we passed last week simply says you can’t label (or restrict) a single, locked-room bathroom for any one gender.

This is probably a victory for women – who often have to wait in line while a men’s room sits empty – and a loss for men – who might now have to wait for an open bathroom.

But if anyone wants to see an impressive way to solve the multi-stall issue architecturally, they need go no farther than the Capital City Grange hall in Berlin.

***

News Media Shield Law

As a lifelong journalist and the daughter of a lifelong journalist, I probably surprised many with my opposition to the news media shield law that passed 140-2 on the House floor.

I suppose my vote was partly in honor of my father, who imbued in me the principles of freedom of the press. As he said, any time the government imposes a definition on who is a journalist and what content constitutes journalism, we are imposing government control on the press. A shield law that protects journalists from subpoenas carves out such definitions.

Interestingly, the head of Vermont Press Association contacted me to say he agreed with my position as representing “constitutional purity,” but wanted me to change my vote to provide practical protections. On this issue, I chose constitutional purity.

***

Samples of “Small Stuff”

We get complaints about being in session too long and mucking around too much passing more and more laws. There were several examples last week of some of the work that really does need doing, even if it doesn’t make the headlines.

Supervising a practice driver while drunk. We all agree that driving under the influence should be illegal, but there was an oversight in the law. Nothing said drunk driving includes being the adult with a license who is supervising a 15-year-old who is practicing driving on a learner’s permit.

Yikes. That needed fixing.

Notary publics. We have a nice, comfy style for authentication of signatures by a notary public. It’s easy to become a notary and a stamp isn’t needed.

We’re in a new era with electronic capabilities, and we also need to be in sync with other states if we want our documents to count elsewhere. I’m not thrilled with the extent of the new regulations, but I need to accept the due diligence of the committee that worked on the bill, and an upgrade was definitely needed.

Sometimes the longest debates on the House floor involve “small stuff.” Last week it was over the “check engine” lights on cars, and the impact of mandatory inspection failure solely because of a potentially faulty indicator light. This is in particular given the new electronic automated vehicle inspection system instituted this spring by the Department of Motor Vehicles.

It’s always refreshing when there is a vigorous but completely non-partisan debate. There was passion over the possible impacts on air quality contrasted against the costs, particularly for persons with low income, for repairs to these expensive electronic systems.

The Transportation Committee supported a proposal to defer the standards for a year to allow a fuller review of the repair options, and despite the opposition, the amendment eventually passed on a 127-11 vote.

***

Back from the Senate

My Health Care Committee’s bill to allow minors to seek out counselling without consent from parents if they are struggling with sexual identity questions has come back from the Senate with a big change. The bill now allows minors to consent to counselling, regardless of the reason.

It’s a big expansion, but it has some logic. If the reason a minor is afraid to have a parent consent is because of abuse at home, instead of sexual identity, shouldn’t they also have that access? Are they not just as much at risk of greater harm – including self-harm – if they can’t get help?

When I was preparing to present our narrower bill in the House, I discovered that 34 other states hold that broader position. Our committee will need to assess how we respond.

***

Family Leave

The family leave act bill may be coming to the floor this week, and it’s one I have very mixed feeling about. Please send input!

I think it’s something we really need and ought to have: the ability to get paid time from work for a new child or family member with a serious illness, paid for by a state-run insurance program.

The problem with an optional program is there likely wouldn’t be enough takers. But do we need the government to step in and take the money from everyone’s paycheck to achieve it?

It is only a small amount of money – about .14 percent of salary, up to $150,000 -- and has a big payoff for our neighbors in need. I’m certainly influenced by seeing my brother’s ability to take long weekends to be with my Mom here in Vermont while she was in hospice care, thanks to having this program in New Jersey.

***

School Districts

It’s been said many times that a law can be simple, or it can be fair, but it cannot be both. As soon as you start carving out situations to be fair in all circumstances, you get complex very quickly.

The bill coming to the floor this week adds another layer of complexity to the allowable school districts governance structures under Act 46, the law from two years ago that aims to improve education and maybe save some costs by requiring mergers into larger, combined, districts.

So what is a Three-by-One Side-by-Side Structure? It’s a new option for mergers, allowed under some situations, and with all sorts of defining characteristics. I read the bill carefully, and I sure can’t figure it out! I’ll be listening closely to the explanation when it is presented on the floor.

***

Budgets

The capital construction bill, the transportation bill, and the state budget are the three “must pass” bills before the session ends, and are due back from the Senate next week. Because of the Governor’s veto threat, I don’t anticipate the Senate proposing new taxes to float a higher budget.

New financial estimates have come in, however, that project higher revenue next year from our existing tax base. It remains to be seen whether the Senate will want to capture that for added spending, or put more aside for much-feared federal budget cuts.

We’ve all been told to save the last week in October for a possible special session of the legislature to reassess our budget status if there are major changes from Washington. The target is to finish the current session a week early so that if we have to come back, it will not be at an added burden to the state budget.

***

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 counterp@tds.net

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 counterp@tds.net

March 25, 2017 Legislative Update

Legislative Update

Rep. Anne Donahue

March 25, 2017

We are hitting the meat of the session in the coming week, as we take up the House version of the state budget.

It appears that for the first time in many years, it will match our actual revenues instead of requiring new taxes to support it. That is thanks to our Appropriations Committee acting under the threat of a governor’s veto.

A good example of how it is possible to address urgent needs without increasing overall spending is the proposal developed by my Health Care Committee to address the psychiatric care crisis that is backing up our emergency rooms. I described that in detail in my last regular report.

***

Marijuana

A long debate on the House floor this week will be on the marijuana legalization bill.

In contrast to the Senate’s “tax and regulate” sales bill that failed a year ago, this bill is about legalizing the possession of an ounce or less, and the growing of a few plants.

I’m not interested in seeing the state go after personal use or cultivation of small amounts of marijuana, so in theory I could support the approach. But there are a number of key caveats for me, and the bill does not include many of them.

Unless floor amendments address those concerns – and there will be plenty of amendments offered and debated – I would be hard pressed to support it.

First, kids: the bill does include some aggressive prohibitions against persons allowing access to anyone under age 21. Does enabling “consumption” include prohibiting parents from exposing their kids to inhaling second-hand smoke? Not clear.

Does the bill include an assumption of child abuse or neglect if children are exposed? No.

The bill also promotes an attitude that marijuana isn’t all that bad a thing for young people, despite all the medical evidence that it is particularly harmful to developing brains, because it establishes possession of up to two ounces by youth as exactly equivalent to possession of alcohol.

Second, safety on our roads. We can’t test for “under the influence” in the same way we can for alcohol. Those who say that is no change from what exists today are kidding themselves if they don’t think there will be more use – and thus more driving while impaired – if use is legalized.

We could, however, enact stringent prohibitions on any use (by a passenger or driver) or even presence of marijuana in a motor vehicle. The bill does not do even that.

Third, public use. My view about personal use doesn’t extend to subjecting me to use by other persons. There are minor fines for public use; I think it needs to be illegal.

That was a flaw in decriminalization several years ago. An amendment I offered then to have a higher fine for public use, failed.

Even “private property” creates issues, because it includes apartments. Unlike alcohol, marijuana intoxicants are carried in the air. Don’t apartment dwellers have the right to be free from exposure to their neighbors’ use of pot?

Yet to make that distinction would create a fundamental inequity between wealthier (home owning) and less wealthy (apartment dwelling) users.

It’s a good demonstration of how difficult it becomes to draw clear lines among levels of how legal marijuana could be restricted to “personal use only.”

I’m not sure why leaving it all at our decriminalization approach (just a fine for small amounts) does not remain workable. There are enough others who feel the same way that a close vote is expected.

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School Finance

Also coming up is a bill to restructure how we set tax rates within our statewide education property tax. It would create a clear connection that would benefit districts that spend less than the statewide average per student, and create a disadvantage for those that spend more.

This makes sense, BUT… it would be retroactive to the current budget year, with budgets already voted on. I have always fought retroactive bills, and will oppose this.

Regretfully, it appears that – having already rejected the Governor’s proposal – we will again do nothing this year to actually address the escalation of education costs.

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Guns

It sounds reasonable on the surface to say that a person who commits domestic assault should have his or her guns removed from the home; that was the premise of the gun bill last week.

But there is a total illogic to say that a person who is an immediate threat to another person, and has been charged with an assault, should be left there with the victim -- just take any guns away and the victim will be safe?

If the person presents that kind of danger, he/she should be kept in custody until a bail hearing, and at that hearing, a judge can decide whether to order that weapons be confiscated. That way, both safety and due process rights are protected.

To merely confiscate all guns in a home, with no court review and only an allegation of abuse, violates a person’s right to their own property without the “due process of law” that is guaranteed by our constitution. It also violates the presumption of innocence when we act based only on charges being filed, without even immediate judicial review. I voted no; the bill passed on a 78-67 vote, very much closer than the often party line divisions on controversial issues.

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Pregnancy

Another seemingly good proposal: require reasonable accommodations (you don’t have to wear the otherwise-required staff uniform; you can have a stool to sit on) so that pregnant employees can continue to maintain their jobs.

Unfortunately, it wasn’t written that way. It includes unlimited amounts of unpaid leave beyond existing family leave laws and “job restructuring” without the employee necessarily being able to perform even the core functions of the job.

We were assured on the floor that the requirement that the accommodation not present “undue hardship” to employers means “they can say no” if, after a discussion with the employee, they feel the request creates an undue hardship.

That turned out to not be accurate. It is a mandate. The Attorney General or Human Rights Commission that would resolve disputes.

If put into practice as written, it could cost the state (as an employer) a great deal of money, so I moved (unsuccessfully) to have it sent for review by the Appropriations Committee.

I hope the Senate addresses some of the overly-broad language, so that I can support this bill when it returns to the House.

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Mental Health

I reported two bills on the House floor. The first creates a review committee for interactions between police and persons who appear to be having a mental health crisis when it results in the use of force with death or serious injury.

The genesis of the bill was the death of Phil Grenon in Burlington last year. Consensus among all parties emerged that we need a way to review such incidents without trying to assess blame (the State’s Attorney review for wrongdoing already addresses that).

So the commission would do an in-depth analysis, determine if there were ways that could have resulted in a better outcome, and make recommendations for the future.

The second bill was part of our effort to address Vermont’s high rate of suicide. (It is the second leading cause of death for young people in Vermont; overall annual deaths exceed those from motor vehicle accidents, murder, and drowning combined.)

One group of teens has six times the rate of suicide attempts of the rest of our kids. These are the kids who identify under the Youth Risk Behavior Survey as “lesbian, gay, bisexual or questioning.”

Some of them, knowing that parents must consent to counselling, will not ask for help in addressing their confusion or mental health crises – even if that support is specifically to enable them to feel able to talk to their parents.

This bill allows minors to get counselling on these issues without parental consent.

It is certainly not an easy thing to allow parents to be excluded in this process, but the need is obvious and urgent. I was gratified by the House support of my report with a 125-12 roll call vote.

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I’ve recent a flurry of constituent messages about the bill to create a Racial Justice Oversight Board in Vermont. Most have urged support, a few have said we don’t need it. Sometimes the fact that we think we don’t need something (we’re Vermonters, after all; we can’t have any prejudices!)  is precisely the evidence that we do. I support this bill.

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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 counterp@tds.net

March 10, 2017 Legislative Update

Special Legislative Update: the Health Care Bill in Congress

Rep. Anne Donahue

March 10, 2017

Our Health Care Committee in the House has been waiting anxiously for information on what shape the “repeal and replace” of the Affordable Care Act might take. We’re on town meeting break this week as the news is breaking in Washington on the bill that has been introduced, so I went and sat in as Governor Phil Scott’s staff did a special media briefing Friday.

It’s obviously still very early to know much, but the Scott administration drilled down to make best estimates of what impact it would have on Vermont if the current bill passes. About the only good news is that the major financial impacts would not hit until 2020.

But as feared, it would be a very big hit: potentially a $200 million shortfall in our Medicaid – and therefore our state – budget.

For many of the 26,000 low-income Vermonters who currently receive subsidies to help buy insurance, it would mean a significant drop in assistance. However assistance would be newly available to the next higher income bracket.

Vermonters who get insurance through work as part of the “large group market” would see the least change, but rates might increase more rapidly than they do now, because of what was called “market destabilization.”

There is nothing in the bill that addresses ways to contain cost or reform payment structures. In theory, that will come in a later, “Part 2,” of the repeal and replace.

One of the first things to be repealed would be the individual mandate: the requirement that you buy insurance or face a federal penalty.

One impact of that is an expected increase among those who do not get insurance, and since those people tend to be healthier individuals, it increases insurance premiums for everyone else who remains. Those without insurance still get care if they end up in a hospital, so that cost also gets shifted to everyone else.

The new tax credits would be based on age groupings, up to $75,000 in annual income – the same rate regardless of whether you earn $20,000 or $75,000.

Here are the contrasts that were presented between current subsidies and the proposed law:

An individual earning $20,000 currently can receive a subsidy of $4,920 for a “silver” plan that costs $6,251. That leaves them with $1,331 to pay – still pretty steep at that income, and that is just the premium. A silver plan still leaves some pretty high co-pays and deductibles.

Under the new proposal, that individual would receive a $2,000 credit if they are age 27, a $3,000 subsidy if they are age 40, and a $4,000 subsidy at age 60. Part of the premise is that insurance is more expensive as you get older, but that isn’t true in Vermont, where insurers are not allowed to charge different rates based on age.

For someone at a $40,000 income level, the current subsidy is $2,016. So it would stay about the same for the 27-year-old, who would get the $2,000 subsidy. The 40-year-old would do better, with the new $3,000 subsidy, and the 60-year-old would receive almost double the current subsidy.

At $75,000, no one currently gets a subsidy, so regardless of age it would be a bonus for those folks.

It gets more complicated when you introduce families, but one sample family of four, including two children, gives the basic picture:

At a family income of $51,020, with two children eligible for Dr. Dynasaur, the cost for a health care for the family is $14,060. The current subsidy under the Affordable Care Act is $9,110, leaving the family with $4,950 to pay in premiums.

Under the new proposal, the subsidy would drop to $5,000, so the family’s cost would be $9,060.

So what happens if you can’t afford insurance, and drop your coverage, and then realize it was a mistake, and sign back up? If you allowed more than two months to lapse, you get hit with a penalty of 30 percent of the cost of the plan: a major disincentive to buy insurance.

As Vermont’s new Secretary of the Agency of Human Services said, one of the problems with the Affordable Care Act was that for most individuals, health care was still unaffordable. If the bill before Congress passes, it will become more so.

Vermont prides itself as the state with the second-highest level of persons with health insurance coverage – about 97 percent have coverage. That rate would certainly fall.

There are a lot more details yet to dig through, and a lot of uncertainties, including what changes the bill might undergo in Washington. So it will continue to be a waiting and watching game, but in this first iteration, the picture is as ugly for Vermont as has been feared.

March 3, 2017 Legislative Update

Legislative Update

Rep. Anne Donahue

March 3, 2017

Town meeting week break: it means we are almost half way through the session. The week we return, known as “crossover,” is the deadline for policy bills to be voted out of committees in order to be voted on and cross over from House to Senate, or vice-versa. It will be a packed week with committees working late to finish work on proposed changes in laws.

One week after that is the deadline for the money bills, which are required to start in the House. That includes the annual state budget and the 2-year capital budget, along with any tax or fee bills.

The budget dynamics are all new this year, because we have a governor who has drawn a line in the sand: he will not sign a budget if it requires new taxes or fees to balance it.

I have heard no talk in the House this year, thus far, about trying to challenge that and attempt to override a veto. The Appropriations Committee is chewing through budget details to look for savings and cuts – and asking for policy committees to weigh in.

In Health Care, my committee, we grappled with two subjects that Appropriations asked us to review: analyzing the savings proposed in the governor’s budget, and looking at what we could do this year, on an urgent basis, to respond to the crisis in meeting mental health care needs.

Mental Health

The issues that have led to days of waiting for psychiatric patients in the emergency rooms of our hospitals are many-layered. This backlog has been ongoing for several years now. The prior administration kept saying that the “flow” of the new, post-Irene system just hadn’t fully calibrated itself yet, and needed some time. It is clear now that the problem is deeper.

Any plan to completely restructure a system on a crisis time frame – the crisis being the sudden loss of the Vermont State Hospital due to flooding from Irene in 2011 – is likely to run into trouble. The plan was inadequate from the start.

Our work to make revisions needs to be more careful, yet there is huge urgency. Last fall, for example, an 11-year-old boy from Northfield was held in an emergency department room at Central Vermont Medical Center for six days while waiting for an inpatient bed to become available in Brattleboro.

The task before my committee was to identify targeted actions – and the money to achieve them – that might help allay the worst of waits like that while longer-term system solutions are developed and take hold.

In keeping with the governor’s line, however, “the money to achieve them” meant finding resources that could be shifted based on priorities, rather than increasing the budget (often referred to as a “budget neutral” proposal.)

I led a work group from our committee, and by Friday, we had achieved that goal. It doesn’t mean everyone will like it or that the Appropriations Committee will agree.

Here is what we recommended:

Inject $2.5 million into the crisis intervention system to steer patients away from emergency rooms if they don’t need to be there. We have mobile crisis teams throughout the state, but they often can’t stay staffed because salaries aren’t competitive, and there aren’t enough clinicians to meet the need.

Add $.5 million into new initiatives to create nursing home capacity and supports for elderly patients who are stuck in psychiatric inpatient beds solely because there are no nursing home beds available to meet their needs.

When people stay in the hospital after they are stable and ready for discharge, it uses a space that could otherwise be for a new admission; instead, the person waiting for admission sits in the ER.

Another set of persons who are delayed in discharge are those who are homeless. The last piece of our proposal is to add $.4 million into specially-supported housing for such individuals.

Where’s the Money?

That’s $3.4 million in total… from where?

One part of the governor’s budget proposes cutting 10 percent of special payments to hospitals called “DISH” payments. It is federal money, matched with state funds, that is intended to help hospitals with the costs of free care they provide to persons without insurance.

Over the past five years, the amount of that unreimbursed care has dropped significantly, because our rate of uninsured persons has dropped. The governor felt it was reasonable to reduce those payments.

We looked at that and considered: if we cut the payments even further, but reallocated the additional money to help address the emergency room crisis, it was actually shifting the money to a different category of need at the hospitals: the need to relieve the backlog.

Cutting a second 10 percent of the DISH payments but reallocating it to the targeted mental health responses seems like a better way of using the same money. Ten percent equals $3.4 million, which became the basis for the recommended levels of emergency new funding.

Elsewhere in the Budget

Other health-related budget items we reviewed included the governor’s proposed savings in Vermont Health Connect and in the administrative functions of the Green Mountain Care Board, which oversees health insurance and hospitals in the state.

The governor expects to save $2.8 million by re-directing individuals who are not receiving subsidies to get their insurance directly from the insurance carriers, rather than signing up through the Vermont Health Connect exchange.

We started allowing people to use direct enrollment just a few years ago, when Vermont Health Connect was failing rather catastrophically to meet enrollment needs. Now, we realize we can save money if they all opt to do it.

The problem we found it that the amount of the savings projected is highly optimistic. We warned the Appropriations Committee to use caution in booking the full savings.

On the second issue: The Green Mountain Care Board is partially funded through billing the insurance companies and hospitals they regulate. It is a common funding mechanism for regulated entities.

The governor’s budget identifies a savings by increasing the amount of the Board’s budget being billed to insurers and hospitals, and decreasing the amount being paid for out of the state’s budget.

That sounds rational, but there is a glitch. The state budget money is matched by federal money, at least for now. The costs that are billed to insurers end up being paid by individual purchasers of insurance, in their rates, and there is no federal match. Depending on the insurer, this could mean up to $72 per person a year as a rate increase.

So by shifting the source of the funding, we are losing out on the ability to get federal money to help pay, and instead placing the full cost on the purchasers. In cash terms, to balance it out means we would no longer be using $1.2 million in federal matched money; we would be billing $1.7 million more to insurers (purchasers); and the grand sum of the desired savings for our state general fund budget would be $180,000.

It’s all in the interest of a balanced state budget, but it isn’t a true savings in costs. It is simply shifting the costs from taxpayer to ratepayer. They (we) are often the same people.

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On the House Floor

The hottest topic of debate last week in the House was a bill to shorten the length of time after a sentence is served that a person can apply to have a criminal record wiped clean.

I support the concept of expungement: that if you have paid for your crime and have then proven yourself in staying clean for long enough, you should be able to get a new chance at a clean record.

The issue was how long is “staying clean for long enough.” Our expungement law is fairly new, and this bill reduces the waiting in one category from 20 years to five, and another from 10 years to three. I think that too much, too soon, so I voted “no.”

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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 counterp@tds.net