We don’t get the “fake news” that plagues
social media, when it comes to our local news outlets, but that doesn’t mean we
don’t get our news twisted up. The word-of-mouth floating around about Governor
Scott’s proposal for a privately-run prison and mental health facility that
adds 925 new beds is a good example.
Virtually every word in the sentence above
is inaccurate, but has shown up in someone’s version in describing the plan. My
committee heard the full overview directly last week.
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There
is no proposal for a privately-run facility. The suggestion was that it might
be constructed through a private company and then rented to the state to avoid
having the state carry the $125 million construction price on its books. But it
would be run by the state.
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There
is no plan to add 925 beds to our prison capacity. The facility would replace
two existing prisons that are more expensive to run and maintain because they
are outdated. It would also bring back the prisoners that we currently send to
out-of-state prisons.
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There
is no plan to address mental health needs by creating a new “prison and mental
health facility” on the same site. The mental health part of the plan is for
providing services to inmates in corrections, not for co-mingling prison and
mental health needs.
There are many reasons that I’m not sure
the plan makes sense, but if I oppose it, I want it to be for the right reasons!
The pros include the fact that I really
believe it is wrong for us to send Vermonters to prison in other states – or if
we do, that we should be giving those inmates a shortened sentence. It is not
equal justice for one person to be send hundreds of miles away, while the other
can maintain connections with local family and support systems.
There is also an urgent need to provide
mental health care within corrections. We are required to provide appropriate
medical care to the people we hold in prison, and many are not receiving it
when it comes to mental health.
The cons include the challenges of
recruiting enough staff for a large, consolidated prison in a rural, northwest
corner of the state. The mental health plans include a 20-bed forensic
hospital, which means recruiting psychiatrists and other medical personnel to
serve there, an even more difficult task. This is a healthcare specialty that
already has shortages, and the state has been unable to fill staff positions at
the psychiatric hospital it runs in Berlin. Staff there frequently are forced
to work mandatory overtime shifts, creating dangerous conditions.
I’m also very concerned about the way the
whole proposal has blended and mixed up what Vermonters need. The proposal
arose from a legislative directive to review the state’s needs in a number of
different areas. One high priority for our state is, in fact, mental health
care – a whole separate subject from corrections. The two subjects are being
tied together in a way that feeds on stigma and discrimination against those
who have mental health needs.
There are people with mental illnesses
that commit crimes. There are men who commit crimes. The vast majority of
people with a mental illness do not commit crimes. The vast majority of men do
not commit crimes. Let’s not confuse things just because two categories have an
overlap.
Anyone following the news in the past year
knows that we have a health system crisis in Vermont, resulting in people
spending days, and sometimes weeks, waiting in emergency rooms for a hospital
bed, because of a lack of access to mental health care.
There are no direct proposals in the new
plan that address that lack of access.
The indirect proposal is the suggestion
that because there are some current hospital patients who are also within our
criminal justice system – those who overlap the two systems – if we open a
hospital wing in a prison it will free up some current hospital beds for people
who are waiting in emergency rooms.
It’s a hypothesis that some experts are
questioning. Many of those waiting, for example, are children; the plan creates
no new space for their needs.
Speaking of children: another part of the
mega-prison plan is to potentially also have one building on the campus for
juvenile offenders. It’s a back-up plan, if we can’t get federal funding to run
a new facility that would replace the current one, Woodside, in Essex. That’s a
proposal enough to send chills up the spine of any professionals who address
the needs of children.
So legislators will need to see a lot more
data before coming to any conclusions about whether this plan moves us any
closer to solutions – or to decide upon alternatives.
***
Last week we heard the governor’s annual
budget address. I’ve heard enough budget addresses by now to know how much they
are all the same: full of ideas that sound great, but impossible to judge until
we see the actual numbers.
It is certainly vital to protect against
increases in taxes and fees that grow faster than the economy – and our
paychecks – and I applaud the governor’s commitment to that. His desire to
invest in economic growth is also important if we are going to keep our ship
afloat.
But every budget is about where and how
priorities are juggled: what moves to the front of the line, and what gets
pushed back. That’s what will need legislative scrutiny.
It is hard to figure out how the schools’
budget gap will be filled to prevent a major property tax increase. Last year,
in the compromise that ended the stalemate between the governor and the
legislature over teachers’ health care, rates were artificially lowered by
taking money from savings that would have helped out this year. In that way,
the legislature could say it kept tax rates down without giving in to the
governor on the health insurance plan.
Now, some people seemed surprised that we
have a shortfall. It’s going to bite us this year, and every year, if we can’t
figure out how to slow down the growth in costs.
***
My health care committee held an evening
public hearing last week on access to health care, with a particular focus on
access to primary care. It was a depressing hearing, since most of the 50 or so
citizens who testified are people having real challenges in getting affordable
care. Most were pressing for the legislature to go back to work on creating a
universal, single (state)-payer health system, or at least to start on that
path by creating a universal primary care system.
What people did not seem to realize is
that we cannot control a decision like that, unless we want to try to run a
system with less than half the money it currently runs on. We live off the
federal system and federal money, whether it be through Medicare, Medicaid, or
tax benefits. If they don’t give permission, we lose the money.
The so-called “All Payer” model that we
are beginning to test in Vermont right now is based on following the structure
that the federal system allows for. The federal Medicare system established the
“Accountable Care Organization” model that funnels the money to an organization
that is in charge of coordinating care with a goal of more efficiency and
better outcomes.
Vermont is trying to piggy-back on that,
by having the state Medicaid program and private insurance companies use that
same organization (“all payers”), hoping for even greater efficiencies and
reduced administrative costs, with more time for doctors to care for patients.
Based on the testimony we’ve been hearing
in committee, the new approach is still in its infancy, and most Vermonters do
not yet have their care being coordinated by “One Care,” the ACO that is in
place here. You will know if you are brought under its umbrella through a
letter; whether that happens depends on which insurance you have and who your
primary care doctor is.
At best, however, all this reorganizing
will only make price increases a bit less steep. We still have a health care
system that gives great protection to the very poorest, and excellent coverage
to those with employers who can afford to offer good benefits. But despite the
subsidies for lower income families, health insurance and out-of-pocket costs
continue to take a bigger and bigger chunk out of the paychecks of the majority
of Vermonters.
When we talk about affordability, it can’t
just be about taxes. It has to be about all of our essential needs. We must
just keep plugging away at whatever gains we can make.
***
Please stay in touch as you hear about
issues affecting you and to keep me informed about your views. You can reach me
at adonahue@leg.state.vt.us. Thank you for
the honor of representing you.
