January 12, 2018 Legislative Update

New year, new legislative session, new email, new address, new phone!

You may note that you are now receiving this from my legislative email, rather than my home account. That’s partly because I’ve changed my primary account – the old “counterp” account is being phased out – so this is the best one to use for legislative business. My new home email is annedonahuew1@gmail.com. I’ve also moved “downtown,” off Turkey Hill to 633 North Main Street, Northfield; phone number 802-249-4071.

As we begin this new session, please make sure to let me know if you do not want to continue to receive these updates so that I can remove you from this list.

We’ve jumped quickly into business this January. Since it is the midpoint of a biennium, we eliminate the learning curve time for new members, and many bills are still in motion from last year.

So in fairness – contrary to some media reports – the House did not take up the marijuana bill the first week because it was deemed a highest priority bill. It was because it was on our calendar already after having been sent over by the Senate last year. More on that bill, later.

In my Health Care Committee, we are facing a heavy lift with addressing the impacts of a number of federal changes. Some of them are highly technical health insurance provisions, but they could affect our insurance market in some very negative ways.

One of those is the loss of the pass-through subsidy of the purchase price of plans for lower income folks. The money went to insurers to pay the difference of the reduced cost plans they were required to offer.

The money is gone, but the requirement to offer those plans is not. Without the subsidy, the cost to continue to offer them would have to be spread out to other health care insurance plans (the rest of us.)

There is still a different subsidy available, directly to lower income families. If the cost of the insurance premium increases, that subsidy increases. So one solution is for insurers to increase those premiums, which means families get increased subsidies, and end up paying the same.

That’s the easy part. Then it gets complicated.

Raising those premiums would mean that persons who do not get subsidies would be paying a far higher price to buy those same health care exchange plans.

To prevent that impact, we need to allow insurers to offer plans that are almost exactly the same as the ones on the exchange, but at a lower cost, so that the people affected in that way can continue to purchase those plans at their previous, non-subsidized cost, instead of at an inflated cost.

They will need to know to look for those plans directly from insurers, rather than on the health care exchange – a critical point, as otherwise they will get stuck with a very high price tag.

We are rushing that legislation through right now, because the insurance rate-setting process for next fall gets underway in just a few weeks.

The irony of all of this contorted accounting is that the federal government will actually end up sending more money to Vermonters under this system then they would have.

The federal change reduces health care dollars coming to Vermont by about $12 million. Under the revisions, we will be bringing in about $16 million – a gain of about $8 million.

The point of our legislation is solely to protect Vermonters from the federal change, but the effect will be to actually lower costs a bit for some people.

So what happens when the federal government discovers it is losing money through its changes? (Vermont is one of some 37 states who are adopting this fix.)

Everything may change again. It’s a pretty frustrating picture.

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One of the most unpopular parts of the Affordable Care Act has been the “individual mandate” that requires everyone to buy a health plan or face a penalty. The recent federal action to eliminate that penalty has been welcomed by many.

One of the most popular parts of the ACA has been the requirement that insurance covers “pre-existing” conditions: just because you already had diabetes when you bought the plan, they can’t deny coverage for the care you need.

What most people don’t recognize is that those two pieces are linked in a critical way.

Homeowners’ insurance wouldn’t sell you a policy if your house was already on fire. If you could wait until then to buy coverage, why would you ever pay for coverage before you needed it, in other words, unless and until your house was on fire?

If we aren’t required to buy health insurance, but when we choose to buy it, any conditions we already have are covered, why not wait and buy insurance only when we “need” it because we develop a serious and costly illness?

Insurance as a concept is premised on everyone paying into the pool of money that is used to cover unpredicted expenses. If pre-existing conditions are covered, and the only people who buy it are those who are already in a need of a lot of care, the “insurance” is going to end up costing as much as the care itself. In other words, the whole concept of insurance falls apart.

That is why Vermont is going to have to take a serious look at whether we need to create a state requirement for coverage – much as Massachusetts had prior to Obamacare – in order to maintain a reasonably stable health insurance market.

A bill to do that will be getting review in my committee in the next several weeks, and will require a lot of consideration.

There may be a good amount of pushback on this. It is our human nature to want it all – in this case, maximum access to the health care we want, without the government forcing us to pay for it.

Part of increasing costs is our increasing use of health care. It costs real money. We do have to pay for what we want.

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At the same time as struggling with health care costs, we – the big “we,” as both state and nation – are continuing down the path of legalizing the use of marijuana.

I won’t repeat all the pro and con arguments here, and there are many of them on both sides. I find it hard to object to the concept that adults who are doing things that do not harm anyone else should be allowed to do those things legally.

But we do prohibit a lot of things under that category. Riding a motorcycle without a helmet comes to mind.

The real question is whether there will be an increase over existing harms (the risks to younger folks if they access it more; the risks created on our highways if there is an increase in impaired driving) through legalization, and the extent to which we will work to minimize the increased risks that do occur.

I was disappointed with the very mild compromises that emerged in the final bill that the governor agreed to sign. The bill does include penalties for use of pot in a car (including by non-drivers), which was an amendment I first brought to the House floor last year. The penalties are increased if a child is in the car.

But both last year and this, I also pushed for penalties for using pot in any enclosed space with a child. The negative picture I can’t get out of my mind is of a group of folks at home, enjoying some casual marijuana (OK, fine), in a room in front of their kids (not OK.)

Some news media reported that I offered an amendment to increase penalties for use of marijuana in enclosed spaces when children are present. That is inaccurate. There are no penalties in the bill; my amendment would have created some.

It failed, and I voted against the bill. To me, the sad reflection was those only a handful of those who supported the bill were willing to support my amendment to it.

The member of the House who is also a practicing MD (and who opposed the bill as a whole) was more than just saddened. Rep. George Till said in a written comment on the vote: “this is the low point of my 10 years in the legislature, to see so many people I respect not vote to protect our children.”

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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.