Legislative Update, May 12, 2019

Legislative Update

Rep. Anne Donahue

May 11, 2019

In theory, the current legislative session ends on Friday, May 17. There’s healthy skepticism about achieving that date, given that the major, “must pass” bills are not yet or just coming out of the Senate and will still need to be reconciled with the House versions.

These include the budget bills (operating and capital), taxes and fees.

Most of the other stated priorities for the session have not yet passed out of their second body, let alone reached a conference committee to iron out any differences between the two.

These include minimum wage, paid family leave, regulation of marijuana sales, and a gun purchase waiting period. They are not “must pass” in order for the session to end, and could stay in play for next year instead.

***

School Merger Delay

One bill that appears completely stuck is the effort to allow towns who are under forced merger orders (like Berlin) an extra year to work out the details of the merger agreements. The House and Senate cannot agree on who should be permitted a delay, and who should not.

If no agreement occurs before the end of the session, the mergers will take effect on July 1.

***

Clean Water

Everyone wants water clean up (it is hard to even think of Vermont as a state with water pollution problems), but the challenge has been to figure out how to pay for it.

I have agreed that we cannot get the funding by squeezing more money out of our existing budget responsibilities, and this week I voted in support of the House proposal to raise $7.7 million for this purpose.

I have had big concerns about whether we are making effective use of the funding, and the House bill does a lot of restructuring, hopefully to improve that system.

There are shifts being made in terms of which taxes go to which funds, but the area that the new money is being drawn is a “cloud tax.” The language of our new world – we’re taxing clouds?!

Only a few years back, if you wanted a new program for your computer, you’d go buy the CDs at the store to download it, and pay tax for that. Now you “buy” it by getting access to it in the “cloud” of cyberspace, and that has been tax exempt.

So the intent is to recapture that sales tax revenue. The overall clean water bill, including the tax, passed on a vote of 124-14.

This major bill is now on its way back to the Senate, which will respond by agreeing with our changes – unlikely – or asking for a conference committee – likely – to try to achieve agreement.

***

Plastics Ban

The other big bill last week was the proposed ban on single-use carryout plastic bags and other plastics.

It’s been at least a decade since I first co-sponsored a bill that would have placed a fee on plastic carryout bags. The momentum never developed for that, and I think it’s high time we started addressing our current throw-away society habits that spread trash around the world.

This bill bans bags at point-of-sale (so they are still permitted at the vegetable bins or to wrap meats, for example.) It also bans sale of the plastic foam containers that we use for takeout food and coffee, stirrer sticks, and plastic straws (unless by direct request at a restaurant.)

For many years I thought I was being eco-responsible by asking for “paper, please” at the grocery store, but it turns out they aren’t much good either. While they may biodegrade over time, production and transport is very resource-intensive. We could do a lot better by bringing our own bags.

This bill still allows them if they are from recycled products, but permits stores to charge 10 cents apiece. Oddly, not less than 10 cents.

That price tag may push more stores to stay with giving them out for free, which would be counter-productive to the intent, but the committee that proposed the bill pushed back against proposals for a lower charge.

Despite extended debate, the bill passed on a healthy 120-24 vote, and heads back to the Senate for review of the House changes.

***

Abortion Access

Proposition 5, the so-called abortion rights amendment to the state constitution, passed on a vote of 106-38. Under the rules for constitutional amendments, no change from the Senate proposal was permitted, so that was the final step for this year.

It must be passed again by the legislature in the 2021 session, and then be adopted by a public referendum.

The language appeared on the surface to be more balanced than the abortion rights bill that passed earlier this session (and which has now also passed the Senate.) That bill sets no limits at all, while the constitutional amendment proposal allows for the state to act if “justified by a compelling State interest,” similar to the Roe v. Wade balancing standard.

Our constitution, however, makes the premise of rights based on the fact that “all persons are born equally free and independent,” which may not allow for the state to claim any interest in a child not yet fully born.

Of greater concern is the language of the new right, which is a right to “reproductive autonomy.” That’s a fairly new term of art that the presenter of the bill said means abortion, contraception, sterilization, and the right to bear a child.

It isn’t defined anywhere, and once language is in the constitution, its interpretation is fully in the hands of future courts. It is a term that could take on a lot of meanings, whether intended or not.

This could backfire even for proponents of unrestricted rights of women, since a man’s right to reproductive autonomy would become co-equal. What happens if a man does – or does not – want to become a father and has a different opinion from that of a woman carrying his child?

I think that in the rush to protect women’s rights (which are not currently under any threat in Vermont), too little was done to carefully consider what the wording for this proposal should actually be.

As someone who believes we must continue to confront how to balance two important issues in the abortion debate – both a woman’s bodily autonomy and the autonomy of the genetically distinct life growing in her body – I could not have supported it, regardless.

The precise wording, as passed, states:

“That the people are guaranteed the liberty and dignity to determine their own life’s course. The right to personal reproductive autonomy is central to the liberty protected by this Constitution and shall not be denied or infringed unless justified by a compelling State interest achieved by the least restrictive means.”

***

Medical Records

In my last update, I discussed the issue of medical records privacy and our state’s health information exchange, which allows health providers to access a patient’s records from across the state through a single database.

The issue was a change being proposed from our current consent system, which requires your consent for your providers to use it, into a system where access is automatic unless you specify that you do not want other providers to be able to access it.

If the legislature did not act this year, the change would have gone into effect under criteria the Green Mountain Care Board decided upon. I felt strongly that the legislature had a responsibility to make a decision of this significance.

My committee did agree to tackle it. We started the discussion with widely disparate views. Our discussion process was the kind we would all wish for when tough decision-making is at hand. We heard all views. We really listened to one another. We brainstormed options.

The final result was an 11-0 vote to approve the change, but setting stringent standards for a transition plan that will fully inform Vermonters of their rights. If we decide the transition plan isn’t strong enough, we have a window of time next year where we could pull the plug.

Our proposal was adopted on the House floor this week, and the Senate has already indicated informally that it supports the approach.

***

It is truly an honor to represent you. Please contact me with your concerns and thoughts; I’m best reached via email at adonahue@leg.state.vt.us. My past legislative updates are available at representativeannedonahue.blogspot.com.

Legislative Update, April 27, 2019

This session is unusual in terms of the progress (or lack thereof) of major bills. We should be having some long days on the floor by now, debating some of the larger issues on bills that already passed the Senate and are coming out from House committees.

It hasn’t happened, and nothing is even teed up for action in the week ahead.

That means either we will be having some really late nights in the final two weeks of the session, or some major bills are going to be held over for next year.

At the end of a two-year biennium, everything dies and must restart in a new session. Since we are in the first year, anything that doesn’t pass stays where it is and can continue on its path next year.

***

In my Health Care Committee, we are grappling with a topic that I feel some passion about.

I’ve been here long enough to have seen two previous occasions where we threatened to break, or did break, a promise to Vermonters about the privacy of health data that the state was collecting.

Early in the opioid crisis, we created a statewide prescription database. You have no option about being included.

But we premised it on an absolute standard: we were creating this for health intervention, to help doctors identify those who might need drug misuse treatment or need to be blocked from further prescriptions.

It was not being created for law enforcement purposes, and we were explicit about that.

A mere four years later, the Senate waged battle to open the database up for police investigations. The House held firm (we would have approved if there was a warrant requirement), but it was a bitter fight.

In earlier years, a data base had been established to keep track of numbers and avoid duplication related to people with an HIV-positive status. The privacy commitment we made was that the data would be held between double-locked doors (figuratively.)

Then the federal government came along and said that AIDS funding would be conditioned upon access to the data with only one lock on the door. AIDS service groups supported the change because it preserved important funds.

Advocates, however, begged us not to break the promise made. We did it anyway.

Once you create a data monster, it is difficult to preserve the guarantees made as the basis for getting support for the data base. It’s too late to not create it.

So now we come to today’s question.

Your health care records are gathered – without your consent – into a state health information exchange (HIE). It’s an electronic data base for purposes of access to medical information among doctors, and it is an important system to ensure best-quality care.

Folks like the ACLU were pretty concerned when we created the Vermont HIE back in the early 2000s as part of a federal initiative to improve electronic transfer of health information.

So there was a very important agreement. The records would be gathered, but could not be accessed unless patients signed an informed consent.

The only exception was in emergencies with an unconscious patient. A “break the glass” system allows access to doctors without consent in those situations.

Your primary care doctor is supposed to give you information about the HIE, and ask you whether you agree to allow your providers (only the ones involved in your care) to be able to access those records.

This is called an “opt-in” system: you choose whether to opt to be in the system, as a benefit for your care.

The vast majority of Vermonters who have been asked have said “yes.” They see the benefit of not having to be asked to sign consent every time one doctor needs to get access to records from another.

But we have a big problem with our HIE. It is so underutilized that its value is impaired.

The state has poured millions of dollars into the system over the past dozen years, but doctors have little faith in it. There are problems with avoiding record duplication or record mis-matches between people with similar names, for example.

A big part of the problem has been dysfunction of the legal entity the legislature created to run the system. It’s a non-profit named VITL (Vermont Information Technology Leaders.)

Last year, we finally came to grips with that dysfunction, and gave VITL a year to clean up its act or be defunded. It would have been a difficult threat to enforce, because starting all over would have been mega-expensive.

VITL has begun to get into shape, but has come back, with the support of a legislatively-established work group, identifying a major obstacle to success.

The “opt-in” system, they report, is not working. Only xx% of Vermonters have been asked to consent. The system, as built, is too cumbersome for doctors to engage their patients in the consent process. And without most people on board, the system can’t work effectively.

VITL wants to shift to what most other states do, which is called, “opt-out.” This means your records (the ones we’re already collecting and storing) automatically become available to any of your providers, unless you take the initiative to say, “no, I do not consent.”

As currently planned, you won’t even be informed directly that you have the right to opt out. You’ll have to learn about it through public education efforts. (Maybe there will be a poster in your doctor’s office.)

It’s important to note that the vast majority of Vermonters – xx % -- consent to their providers having access, when asked.

But it is not only the rights of the minority who do not want to consent that are at stake here. It is your right to giving direct informed consent, even when the answer is “yes.”

The decision to create the system and gather patient records was created in statute, but the concept that there had to be informed consent for disclosures was an underlying assumption and not written into the law.

What that means is that if the legislature is silent on the issue this year, the decision to shift to an opt-out system (you won’t be told about it, but will have to say no if you don’t want to be a part) will be made by the independent Green Mountain Care Board, which has already signaled its intent to approve that shift.

The big, underlying philosophical question is who actually owns your medical information? Or the control of it? You might be surprised to know that hospitals and providers will assert that they own it (because they created the records.)

That would be consistent with federal law, but some states – New Hampshire, for example – have said that patients own their own information.

I believe it is critically important that the opt-in/opt-out decision be made by the legislature, accountable to Vermonters, not by an independent body.

It might well be that we have to agree to the change, but it would at least position us to set standards, such as a requirement that patients be directly informed about the existence of the HIE and their right to opt out.

We don’t have time left this session to fully sort through these issues, but I think we can survive another year without making any changes.

So I’ve drafted language that would delay any action by the Green Mountain Care Board by a year, and would establish a legislative study committee for this summer and fall to hold public hearings and dig more deeply into the question of whether, and how, the change might be made.

That committee would make recommendations to us in January so that we could make a more informed decision about how to proceed.

We’ll be discussing – and likely finalizing – a decision about proposing this approach to the Senate sometime in the coming week. If it is important to you, you might want to reach out to your Washington County Senators to urge their consideration.

***

The only other major action in our committee has been our response to a Senate bill that would license ambulatory surgical centers that are not a part of a hospital.

We haven’t licensed them before because they haven’t really existed here, though they are common (and licensed) in most other states.

We’ve had only one for a number of years – an eye center in South Burlington – but now have a new one about to open in Colchester for general surgery.

The new center has been intensely controversial. In concept, it would be obvious that surgery that does not need a hospital setting to be done safely should be available outside of a hospital. It can be more accessible and less expensive, since it has less overhead.

However, Vermont’s small size creates a distinctly different health care system, and our current dysfunctional payment system complicates things immensely.

Hospitals are not paid based on the actual cost of providing a service. They are paid on a fee schedule based on what insurers are willing to pay and what will total up in the end to balance their budgets.

Those budgets are highly regulated and tightly controlled by the Green Mountain Care Board.

They also must accept payment from Medicaid and Medicare, regardless of how short that falls of actual cost.

As a result, there are two cost shifts. One is well known: private insurance (and thus, premium payers) are charged more in order to offset the state and federal underpayment.

The other occurs within the hospital operations: some services make money; others lose money. The hospital uses the revenue-producing services to fill in (and be able to provide) the revenue-losing services to their communities.

Surgery is a big revenue-producer.

Thus, these private, for-profit surgery center can charge less than a hospital for the same surgery that the nonprofit hospital offers. If it draws surgery away from hospitals, they lose the ability to shift revenues to pay for other services needed by the community.

That problem would worsen significantly if the surgery centers also turned down Medicare and Medicaid patients.

There was a big temptation in our committee to place major regulations on the surgery center model to prevent damage to financial stability for our hospitals.

We considered, for example, requiring them to go through the same intensive Green Mountain Care Board review of their budgets.

That would have been overkill, because their budgets are a drop in the bucket in comparison. It could have put them out of business, which would not be a fair outcome in terms of access to care for Vermonters.

They also have been willing to agree to accept Medicare and Medicaid.

We settled on a licensing bill that will require Department of Health safety oversight, and will also monitor data on how they perform and how they impact the overall health care system in Vermont.

I will be presenting the bill on the floor next week.

***

It is truly an honor to represent you. My back legislative updates are available at representativeannedonahue.blogspot.com. Please contact me with your concerns and thoughts; I’m best reached via email at adonahue@leg.state.vt.us.

Legislative Update, April 13 2019

Legislative Update

Representative Anne Donahue

April 13, 2019

The family leave bill was voted out of the House last week, and we expect the minimum wage bill to be coming our way soon. How soon, and why the foot dragging on the House side?

The old expression is that in the final weeks of the session (and we are down to roughly four), every bill becomes either a hostage or a Christmas tree. A Christmas tree is a bill that is full of “ornaments.” It is held back to add last minute issues, even if they are only marginally related to the original bill, because the deadline has long passed for new bills. Sometimes the ornament is an entire bill that the House passed, for example, but the Senate has not taken up. So the House tacks the entire bill onto a Senate bill that is still in play on the House side, to force the Senate hand.

A hostage is the reverse situation. If my committee has a bill from the Senate that we know the Senate really wants (and we don’t consider essential), but the Senate isn’t acting on something we passed and really want, we can hold onto its bill until the Senate acts on ours.

Yes, this is pure politics. Politics, but not necessarily partisan politics. House and Senate are both controlled by the same party, but still sometimes have different priorities.In an ironic example, House Democrats fought to pass the heating fuel tax increase to support the home weatherization fund over the strong objection of House Republicans, who felt that it hurt low income families because a sales tax is not proportionate to income. Senate Democrats are now saying they do not want to pass the bill, because it hurts low income families.

The Senate passed its high-priority minimum wage bill early in the session. The House has now handed it its family leave, high-priority bill to the Senate. There is almost undoubtedly a discussion going on at leadership levels about who will move first on which bill.

***

Paid Family Leave

At first blush, paid family leave sounds like absolutely the right thing to do. Several other states have this type of state-sponsored insurance program that covers a percentage of salary if someone needs time for family illnesses or a new baby. Virtually all European countries have done this for years.

The crunch always comes to the cost, and who pays. In Europe, for example, it is usually tax-funded, and income taxes can be 50 percent or higher for the broad social safety net in some countries. The Vermont plan is more generous than the other states that currently offer it (a higher percentage of wage reimbursement, more time off, etc). That will mean it will cost more, and also that the long -term cost is more unpredictable, since we can’t build assumptions based on the experiences elsewhere. It isn’t a pure math equation. Whether more people will use the program because of the higher wage reimbursement, for example, is an unknown.

Then comes the question of who bears the cost. The House bill makes it a mandate for all employees to participate. The nearly $80 million cost (at current guesstimates) will be paid through a payroll deduction. It’s insurance that every individual wage earner is mandated to purchase. There is a core inequity, though, for small business employees. Their employers are not required to hire them back after a leave. (Large businesses do not have to hold a job open, but must give the next available position to a returning employee.) That makes it a big gamble, and less attractive, for those who work for a small business. Sure, you get 90 percent of your salary for the six weeks of leave, but then you’re out of a job. However, you have to pay the same payroll tax as those who face much less of a gamble if they access the benefit. In addition, you will pay this even if you have a summer job as a student, for example, with no eligibility to access it at all.

For those who voted “no” (mostly Republicans, but some Democrats), the biggest issue was about state priority needs. Even though it is insurance rather than a tax, it is still $80 million coming out of the pockets of Vermonters. Is creation of a family leave program the highest priority, if we think Vermonters can pay out $80 million more? One legislator who sits on the House Appropriations Committee, and lives and breathes the budget challenges in meeting the needs of Vermonters, explained her vote by saying, “The $80 million price tag for this bill is way out of proportion to our other critical needs in higher education, environmental protection, and human services. For this reason, I voted no.”

As someone who sits on the Health Care Committee, I would add an even higher priority to that list: access to health care, which is one of the greatest areas of inequity in our state. Some people pay exorbitant costs for health insurance that still leaves them with high co-pays and deductibles. Others have employer-sponsored plans that cover virtually everything. And while we cover the needs of the very poorest Vermonters through Medicaid, we underpay the services we buy for them, so those costs get distributed inequitably among insurance purchasers instead of among taxpayers. With only a portion of that $80 million, we could fill in some of the deepest ravines of those inequities.

There is another more discrete systemic problem with the family leave program we passed. Employees must buy the coverage, but employers can pitch in if they wish – at any level, from five percent to one hundred percent. That can make it a job recruitment and retention tool, some argued on the House floor, by competing for employers based on how much the employer contributes to the premium.

I absolutely cringe when I hear this. After World War II, when a wage freeze was in effect, employers began competing instead by offering to provide varying levels of health insurance.  That was the birth of our system of employer-sponsored health insurance, recognized by most health analysts today as the accident of history that created our gross inequities in health care access. So we now want to create a new benefit – being defined as essential, since it is mandatory – which will create gross inequities in who pays how much, depending upon what an employer contributes? How soon we forget!

I don’t question the value of this benefit. I saw it within my own family when my brother, who is from New Jersey where paid family leave exists, was able to take a long series of 3- to 4-day weekends to commute to Northfield to be with my mother in her final months. But whether, and how, we can pay for it, and whether it is our highest priority, is the issue. And for those wondering, I do not support the governor’s alternative, either. Making it voluntary, with voluntary employer participation as well, worsens the fundamental inequities. I suggested that alternative in last year’s debate, but have reconsidered the core policy issues.

***

Minimum Wage

That leads rather directly into a fundamental problem I see with the entire discussion of increasing the minimum wage. I think there are valid arguments both pro and con for this initiative. While the “pros” are fairly obvious, the “cons” are important: will we sacrifice jobs for some, in the effort to improve wages for others? Will the increase in prices offset increased wage – since the money has to come from somewhere, which means it will come in the costs of goods and services?  Will those who benefit actually lose, as they fall off “cliffs” for eligibility for benefits such as child care subsidies, thus lowering their household income? All those risks are very real and have been deeply analyzed, with no truly dispositive answer in either direction. It’s a gamble.

But that’s not the fundamental problem from my perspective. It is about the critical interplay with employer-sponsored health insurance, which is being completely ignored in the minimum wage discussion. Bluntly put: the difference between an employer who pays 100 percent of top-level health insurance coverage and one who does not offer it at all is roughly $4.50 an hour. Someone making $14 an hour but getting a reasonably good health package may be getting a compensation package worth $17 an hour and doing far better than someone making $15 an hour with no health coverage. If I were that first employer and I was mandated to increase a wage to $15, I might just keep my bottom line even by cutting health benefits by the value of a $1 an hour level contribution. The employee gains nothing. Keep in mind that when an employer does offer good health benefits, employees are “paid” in a highly regressive way. The person making $12 an hour may be paying a quarter of their income (in terms of what is deferred away from wages), while the person making $36 an hour with the same health benefit is only paying 10 percent of their income. Talk about a regressive tax! This is one part of the fundamental inequity of paying for health care this way.

We urgently need to be addressing health access disparities. Although many still debate this, it has become extremely clear that we cannot address it as a small state by creating a taxpayer sponsored universal (single payer) health care system. But we can, and must, work harder at levelling this playing field – and without that, in my mind, increasing the minimum wage is a dubious way of advancing the public good. I would be far more ready to consider a “minimum compensation package” level that included both wages and health coverage than a wage bill alone. That would mean employers who did not offer health care would be the ones who would need to increase wages – better enabling their employees to pay for coverage themselves. I introduced a bill this year that said that minimum wage levels needed to incorporate health coverage in that way, but it has not been endorsed.

***

Guns

The Senate bill imposing a 24-hour waiting period for hand gun purchases has been sitting in the House Judiciary Committee without action after a flurry or early testimony and a public hearing. Is it a House “hostage” bill? Is House leadership worried about support on the House floor? (It is considered a political no-no for a majority party to bring a bill to the floor without the votes to have it pass. That’s why floor debates are usually lopsided and partisan: any debate within a party happens long before that phase.) I don’t know – and thus can’t predict what will happen to it this year.

One thing is clear. At its core, this gun bill is a health care bill. The rationale for the waiting period is completely about suicide. Suicide decisions are often impetuous, and the thought is that just allowing a brief delay could save a life if someone is buying a gun for that purpose but has the time to reconsider. The complex issues about what causes a person to believe that suicide is their only option, and how society can or should intervene, are issues that we have addressed (and will need to continue to grapple with) in our Health Care Committee. There is a much bigger picture here, and it needs to be assessed in its full context. That is why we have committees of jurisdiction, assigned to become the subject experts (to the extent a lay legislature is able to develop expertise.) I have been and will continue to be strongly arguing that my committee needs to be involved in assessing the merits of this specific proposed health care intervention.

***

It is truly an honor to represent you. Please contact me with your concerns and thoughts; I’m best reached via email at adonahue@leg.state.vt.us. My past legislative updates are available at representativeannedonahue.blogspot.com.

Legislative Update, March 30 2019

Legislative Update

Rep. Anne Donahue

March 30, 2019

There are not many bills that generate extensive contact from constituents. (And if you think your voice does not matter, keep in mind that “extensive” in this context usually means 10 to 15 emails or phone messages.)

The tax increase on heating fuel to increase the funding for home weatherization was one of those bills, and it presented a tough issue.

A greater number of individuals asked Rep. Goslant and me to vote against it, but those who supported the weatherization fund made compelling arguments.

This was a question we also asked in the town meeting day poll, and a majority of the 160 who responded opposed this increased tax.

The purpose of the tax (and the proposal to double it from two cents to four cents per gallon) was to increase the funds made available for lower income folks to weatherize their homes.

Increasing heating efficiency has a huge payoff, both in heating costs and in reducing the environmental impacts of burning unnecessary fuel. Those with an income of less than 80 percent of the state median income are eligible, and there is a waiting list.

A sales tax, however, impacts people with lower income at a higher percent of their income than it impacts wealthier individuals, something called a regressive tax. The income tax, as a contrast, is progressive: the more you earn, the higher a percentage of what you earn is taken back in taxes.

Low income advocates insisted this was OK, because it is low income Vermonters who will reap the huge benefits in money saved on heating. That’s true – but only for the small percentage who actually get that benefit. Everyone pays; only a few benefit.

Supporters argued that the average cost would be only about $15 a year. The problem with that is that every tax we add is just that – something added to a growing pile of fees and taxes. It isn’t in isolation, and it’s a real bite for those who are on fixed incomes and tight budgets.

The debate on the bill stretched for hours over two days, with various alternatives being offered. One option would have shifted the revenue source to an income-based tax, and I was leaning towards supporting that, but it was found out of order on a technical challenge.

On the second day, an amendment proposed a compromise: increase the current tax by 50 percent, instead of doubling it (one cent instead of two). I voted in support of this, but it flopped miserably, in a 16-122 vote.

Those who supported the program didn’t want the benefits cut in half, and those who opposed any fuel tax increase didn’t want to only cut the increase in half.

The vote to pass the overall bill was 81-60, with some Democrats joining in opposition. I voted “no.”

Two other tax bills were adopted in the past week. One increased the “universal service charge” on telecommunications bills by a half percent to invest in getting broadband coverage to all parts of the state.

The impact of this on the average user was estimated at $1.20 per year, and I supported it.

Finally, we voted on the overall “miscellaneous” tax bill that made adjustments to other revenues.

The biggest changes this year were an increase in the estate tax exemption level to bring us more in line with federal rates, and a reduction in the exempt level for capital gains. This bill passed on a 116-22 vote, and I was in support.

***

The other two biggest bills were on how to spend taxpayer’s money.

Hopefully, our state budget appropriates it wisely and carefully, and an overwhelming majority of members believed it does. The vote was 137-1; the one “no” vote came from a member who said she felt we should be spending much more to combat climate change.

There was a big injection of funding (almost $8 million) into child care support, and funding was added to our reserves to protect against an economic downturn.

The biggest drain on the budget is the increasing cost -- $21 million this year alone – that we are paying for, as the expression goes, “the sins of our fathers” (and mothers.)

That is for our Teacher’s Retirement Fund, which was short-changed from what the actuaries said it needed in funding over the course of many years in the late 1990’s and early 2000’s. The catchup is painful, and will continue to increase until we are back in line in 2038.

In fact, the General Fund budget growth this year was 3.9 percent over last year, but would have been 2.6 percent if not for the needed increases to the retirement fund.

The second major spending bill each year is the capital bill for state construction projects, funded through bonding (which is then paid back in the regular appropriations bill.)

There were no big new projects this year, but the groundwork is being laid for two. The women’s correctional facility in Burlington is, by all accounts, in deplorable condition and the worst among many of our aging prisons. The planning work is being authorized for its replacement.

In even worse condition is a 7-bed psychiatric hospital step-down residence in Middlesex that is made up of two temporary FEMA trailers, set up in 2012 after Irene. Its projected “useful life” was for four years, but work on replacement has stalled several times.

My Health Care Committee visited it this winter to assess it first hand, and during our tour the operations director attempted to take us through a side emergency exit to access the rec yard. But ground movement under the trailers often causes floor buckling, and a recent, unnoticed result had been that the door was jammed tightly shut.

This was the fire exit. No amount of attempted force got it to budge.

The fastest the state can potentially build a larger, new facility is in four to six years. Our committee joined with the Institutions Committee in pressing for a faster interim solution that could be ready in about two years.

The hospital and community mental health agency in Rutland are willing to team up to build a program there that could function until the state facility opens. It would then convert to another needed use.

This is not an ideal way to proceed, fiscally. We will have to pay the construction costs back in operating reimbursements. But we are at a point of urgency that we need to follow these dual tracks towards closing the Middlesex trailers.

***

The end note of the week was the health care market stabilization bill that my committee had passed two weeks ago. Our bill arrived partially gutted by the two subsequent committees that reviewed it.

Any bill that takes in money must go through the Ways and Means (tax) Committee, and any bill that spends money must go through the Appropriations Committee.

This was the bill that established a penalty for those who could afford to buy health insurance but failed to do so, thus requiring Ways and Means review. (We passed a bill establishing this mandate last year, but wanted to take some time to explore the means for enforcing it.)

The bill also includes all of the protections that can be a part of the insurance market when the pool of buyers is inclusive enough: coverage of pre-existing conditions, bans on annual and lifetime coverage limits, coverage on parent plans until age 26, and so forth.

The Ways and Means Committee decided it didn’t have enough time to fully evaluate the penalty sections, so it removed them. Our committee accepted that change, because the rest of the bill is too important to lose.

We can monitor for another year, and if our coverage rates begin to slip, bring the issue back next year. (We are at three percent uninsured right now, and we don’t want it to creep back up.)

Because the bill included a series of information-gathering assignments to the administration, the Appropriations Committee had to approve the costs for them. It approved the studies, but only if we removed two parts which carried a higher cost because they required actuarial analysis. So we accepted that change as well.

One of those lost pieces was a real disappointment to me, because it was the analysis I requested for the cost to ensure access to primary care for everyone through subsidizing only those who don’t already have it – rather than pursuing the proposal that some are endorsing, to create an entire system of universal primary care.

But that’s why they call the process of creating legislation, making sausage.

Now it goes to the Senate – and who knows how our work will fare over there.

***

It is truly an honor to represent you. Please contact me with your concerns and thoughts; I’m best reached via email at adonahue@leg.state.vt.us. My back legislative updates are available at representativeannedonahue.blogspot.com.

Legislative Update, March 16, 2019

Legislative Update

March 16, 2019

Rep. Anne Donahue

Dozens of bills came out of committees this past Thursday and Friday as we hit the deadline if they are to be considered for passage this year. Next Friday will be the deadline for the Appropriations Committee in the House to vote on this year’s state budget; it then passes on to the Senate.

The word we are hearing is that the budget is among the tightest in years. Costs continue to increase at a rate higher than revenues. New initiatives – even ones perceived as essential – will be tightly constrained because they will require finding offsets through cuts elsewhere in the budget.

For example, the governor has proposed an increase by $7 million in child care funding, and there is pressure to increase this amount by even more to ease pressure on families. However, that increase is drawn from cuts in other human services items, and there is opposition to some of these.

From where I sit on the Health Care Committee, the shortfall in revenue is a great concern. As health care costs continue to rise faster than general inflation, the vision of increasing access gets diverted to merely not losing access. That does not represent progress.

Our priority recommendations as a committee to Appropriations included avoiding new cost shifts onto hospital and insurance rates, and building the state’s mental health services to help remedy the crisis in care that is resulting in people spending weeks waiting in emergency rooms.

We will learn how many of our recommendations will survive this budget process next week.

***

Heath Care Bills

Our committee finished a major bill to shore up the health insurance market in the face of the changes in Washington that are eroding the Affordable Care Act.

There were some parts of the bill that I did not support; we followed a process of straw polls for each section, and not everyone liked every aspect. Those who still want us to be moving towards a universal health care system were disappointed that we are only treading water.

Once the full package was put together, however, we ended up with a tri-partisan, 10-1 vote. It reflects the consensus-building work we aim for in balancing perspectives.

The core component is enforcement of the insurance mandate that became state law last year, replacing the federal mandate. This creates the essential balance for everyone who is using health care to be in the buying pool, so that we can continue to require insurers to cover pre-existing conditions and to ban annual and lifetime caps on coverage.

After lengthy debate, we adopted a modified version of the previous federal penalty. The key adjustments were to better ensure that we are not penalizing people who cannot afford what is available on the market, or who have employer-sponsored insurance but with unaffordable premiums.

In the poll on this section, there were two “no” votes: from a Progressive member who felt we should not have penalties at all as long as the system perpetuates such inequity in what people must pay, and from a Republican member who said that while he agreed that it was important to have everyone contributing, he could not support a fine for the choice to not buy insurance.

I had the most difficulty with the section that will block the return of health plans that are bought by members who get together as an association to form a larger group, and thus obtain lower rates. These association plans were just beginning to re-emerge as an option for small businesses last year after federal rules were revised.

It’s a complex issue that relates to which market pool one is in, and whether small businesses should be prevented from leaving a more expensive pool, thereby stranding those remaining and increasing their costs. The problem is that large businesses are already exempt from supporting that smaller pool, so it creates a real inequity.

My attempt at a compromise to allow these plans to continue for a second year, until we get back a study on whether we could bring large markets into the same, merged pool, failed 7-4 on a non-party line vote.

The bill seeks information back from the administration on the merged pool issue as well as other ways in which we might be able to build more equity into what people need to pay for their coverage.

Included in that is a study on what it would cost to ensure that everyone had access to primary care at no greater than a $10 co-pay. This is the alternative I would like to assess in contrast to proposals for a universal, no cost-share primary care system.

I think a universal system would be very difficult to overlay on our current reform initiatives, and it is also overly-broad. The majority of Vermonters have good access to primary care, whether through Medicaid or through good employer plans.

We need to focus specifically on the minority who do not, and prioritize that issue.

It will be another week before our bill reaches the House floor, as it needs to travel through the Ways and Means Committee and the Appropriations Committee first. It will then get to the Senate for its scrutiny.

***

Every freshman goes through a series of “firsts,” and the biggest one is presenting a bill from their committee on the House floor: explaining the bill and responding to interrogation. My district-mate, Rep. Ken Goslant, passed his test last week with flying colors.

His Judiciary bill corrected a lack of alignment in protection for first responders. There is an “aggravated” level of assault if it is assault on a police officer, emergency medical provider, or fire fighter; there is an “aggravated” level of murder only for police officers; the bill adds the other two.

It is a good example of the kind of unheralded bill that is part of the everyday work of legislative committees to improve Vermont laws.

Much more of that is coming the week of March 19, a reflection of the crossover deadline as the full House considers the work of committees. Apart from the insurance market bill, my Health Care Committee passed three others.

One addressed the issue of female genital mutilation, a cultural practice in parts of Africa which has shown up among some immigrants. Federal law banned it, but a court found that it was a crime that did not fit within the constitutional limits on Congress as applied to state laws. States are scrambling to fill the gap.

Another sets up a rural health care task force to review how to strengthen access in rural areas, in particular in light of the financial struggles of some of the smaller hospitals. There would be no paid members, so there would not be a cost to get its report and recommendations.

The third simply corrects some wording in several Medicaid laws.

To get a taste of this routine work, this is the list of bills on the House calendar thus far this week:

H. 514 – Miscellaneous tax provisions; updates in tax law

H. 518 -- Fair and impartial policing; revisions

H. 521 – Amending the special education laws

H. 13 – Alcoholic beverages

H. 104 – Professions and occupations regulated by the Office of Professional Regulation

H. 133 – Miscellaneous energy subjects

H. 235 – Repealing the sunset of the authority to conduct on-farm slaughter

H. 292 – Town banners over highway rights-of-way [Guess what? They aren’t currently legal …]

H. 330 – Repealing the statute of limitations for civil actions based on childhood sexual abuse

H. 358 – Technical corrections

H. 394 – The disposition of the remains of veterans

H. 204 – Miscellaneous provisions affecting Medicaid records

H. 342 – Qualification for a public defender

H. 427 – A uniform process for foreign credential verification in the Office of Professional Regulation

H. 525 – Miscellaneous agricultural subjects

H. 83 – Female genital mutilation

H. 132 – Adopting protections against housing discrimination for victims of domestic and sexual violence

H. 162 – Removal of buprenorphine from the misdemeanor crime of possession of a narcotic

H. 249 – Additional Reach Up Program benefits

H. 334 – Temporary State employees

H. 351 -- Workers’ compensation, unemployment insurance

H. 460 – Sealing and expungement of criminal history record

H. 523 – Miscellaneous changes to the State’s retirement systems

H. 436 – International wills

Weekend homework for legislators is to preview all these in anticipation of more detailed explanations on the floor.

***

It is truly an honor to represent you. My back legislative updates are available at representativeannedonahue.blogspot.com. Please contact me with your concerns and thoughts; I’m best reached via email at adonahue@leg.state.vt.us.

Legislative Update, Survey Results

Thank you to the 162 Berlin and Northfield residents who replied to the survey on statewide issues that Rep. Goslant and I had available for town meeting. Even though it wasn’t scientific, it does give us an informal pulse on what our constituents are thinking.

The strongest percentage of “yes” responses – 63 percent -- came on the question of whether Vermont should increase the minimum wage over the next five years from $10.78 to $15 an hour. If those who listed “unsure” were removed, the percentage of “yes” votes went to 68.

Almost half of those who said “yes” also answered “yes” to whether such an increase even if the result was the loss of some jobs or of eligibility for benefits such as child care subsidies.

“I’d like to see strong evidence that this would happen even when the increase is gradual over time,” one wrote.

Most of the rest said they were unsure if their position would change. One commented, “I feel there could also be a net gain in jobs as people have more money to spend.”

Several people commented that adding the second question was biased. One said, “This feels like the survey takers trying to lead or sway responses. I’m disappointed.”

The other strong response came in opposition to a tax on home heating fuel to support weatherization and electric car subsidies for those with lower incomes. Only 29 percent of respondents supported the tax; 65 percent were opposed.

Two other questions received a clear majority. Respondents said “yes” 58 percent of the time both to increasing the smoking age to 21, and to establishing a tax and regulate system for sales of marijuana.

More residents of Berlin were unsure, so when “unsure” responses were removed, the “yes” response rate from Berlin was 80 percent for increasing the smoking age, and 70 percent for tax and regulate.

Berlin and Northfield differed some on gun restrictions, with 42 percent in Northfield saying “yes” to increasing restrictions, compared to 32 percent in Berlin. However, 17 percent were unsure in Berlin; only seven percent were unsure in Northfield.

Two other tax proposals under discussion in Montpelier got mixed reactions, with about half of those replying supporting a tax on gas to support municipal roads, and about half supporting dedicated taxes or fees for lake and river cleanup. Many voted “yes” in support of one or the other, but not both.

The proposal for a universal paid family leave program supported by a payroll tax received 46 percent support.

For about 18 percent of those replying, access to primary health care is an issue for their families, and for about 11 percent, access to child care is a direct issue.

The most striking difference between Berlin and Northfield was the level of confidence in the strength of local schools. The question did not ask about cost or tax rates, but only whether “you think the education system is strong in your town.”

In Berlin, 74 percent answered “yes,” 21 percent were unsure, and only five percent (three surveys) answered “no.”

In Northfield, only 29 percent replied “yes,” 30 percent were unsure, and 42 out of 102 surveys turned in answered with “no.”

The most written comments came in response to our request for specifics if the respondent thought there should be more restrictions added for gun ownership. Ten of the 63 surveys in favor listed examples, with the most common being the waiting period for purchases that is under consideration in the Senate.

The questions on access to child care and to primary health care were deliberately asked to identify those who face direct personal obstacles rather than about general concerns.

However, several made comments about health care, regardless of their own access. “I want to look at affordable health for all,” said one response.

Health care “is my number one legislative concern,” said another. “It is totally absurd that we in the U.S. do not have access to the kind of health care that the rest of the developed world enjoys.”

Some replies on child care noted that their answer was due to no longer having children. However, one resident said, “Child care for my two kids takes almost half of my salary.”

The heating tax generated several strong comments. “No more darn taxes! I’m just squeaking by as it is,” said one.

Another commented that, “Carbon taxes disproportionately impact those least able to pay.”

However, in support, one said, “We just must, like it or not.”

Comments from those opposed to increasing the smoking age had a common theme: “At 18, you can fight or die for your country.” “Either you are an adult with all rights and responsibilities, or you are not.”

Some supporting marijuana sales with regulation specified caveats. “Tax hard,” one urged.

“Only if a portion of the tax goes to education,” another said. Concerns about driving and about edibles were also identified. One person said that they had not supported legalization, but now that it had been legalized, it only made sense to tax and regulate sales.

Legislative Update, March 2, 2019

We’re on town meeting break this week – a great time to reach out to Rep. Ken Goslant and me about issues of concern! We also welcome feedback via the survey (in Part 3 of this update) on some of the more prominent issues under discussion in Montpelier; it will also be available at town meeting.

Public Hearing on Gun Bills

The Senate Judiciary Committee will be holding a public hearing on five bills that have been introduced related to firearms on Tuesday, March 12 from 5:30 - 7:30 p.m. in Judd Hall at the Vermont Technical College in Randolph Center.

Details on the bills can be looked up on the legislative web site, legislature.vermont.gov (click on Bills, and then Search.) The bills are S.22, An act relating to firearms (48-hour waiting period and safe storage requirements); S.72, An act relating to extreme risk protection orders (notification); S.1, An act relating to repealing a sunset related to transporting large capacity ammunition feeding devices into Vermont for shooting competitions; S.2, An act relating to the transfer by will of large capacity ammunition feeding devices; and S.13, An act relating to the transfer of large capacity ammunition feeding devices between immediate family members;

Slow Start?

We reached town meeting break week last Friday with extremely few bills having reached the House floor from committees. There were 17, to be exact, but most of those were minor housekeeping or study bills. An example to give a sense of them: changing the membership of the Board of Bar Examiners from nine to 11.

There is no clear reason, other than perhaps an extension of what is happening in my own committee. With almost half the committee made up of new legislators, we needed to spend a good deal of time getting everyone up to speed on history, background, and the highly technical details of the health care system. Every session, there are those who believe we should have term limits in our legislature to prevent people from staying in office for decades and to ensure fresh perspectives. I think we do not have that problem in Vermont. It is essential to have some people with institutional knowledge, and if anything, we tend to be short on that end. A blend is important.

The Friday we return after the break there will likely be a major influx of legislation, because that is the deadline, by Senate and House agreement, for bills to cross over between bodies if they are to be considered for passage this year. (Since this is the start of the biennium, those bills that do not meet the “crossover deadline” can still be considered next year.) The deadline is two weeks later for the “money bills” – the general fund budget, tax bill, capital budget, and fee bill – to pass the House (where they always start) and head for Senate review.

Thus far, we have only had two major floor debates. We rushed to attempt to address the crisis for towns like Berlin that had their merger alternatives rejected by the state and were left with very little time to draft mandatory merger agreements, but that bill now sits in the Senate, unresolved. The other was on the abortion bill, which made all sorts of political theatre but actually would do nothing to either protect or reduce rights of access in Vermont. It is also now in the Senate.

The Senate has been a bit busier (it also has a more stable membership.) It has sent us bills on increasing the minimum wage, a tax-and-regulate system for sales of marijuana, and increasing the smoking age to 21.

Perhaps most important on the very practical level is the bill it passed to exempt cars 10 years or older from the new emissions (or “on-board diagnostic systems”) inspection requirements. Our new system is significantly flawed as it affects older cars, causing serious financial hardship that does not necessarily address actual emission problems. (This is the issue of a “check engine” light that requires repair.) I hope the House will be moving quickly on it.

Health Care Committee

How much do you pay to contribute to health coverage for those who cannot afford it? You probably assume that this is a tax question: what does the state spend on Medicaid and for subsidies for lower-income Vermonters? But if you pay for private insurance, you pay another hidden tax in addition. The medical bills that your insurance company pays are 140% more than they would have been if the state was actually paying for the cost of the medical services it buys. In other words, there is a 40% add-on to your medical bills to make up for underpayments by the Medicaid program.

This cost shift is a silent way of falsely keeping the taxes we pay for Medicaid down. Health care costs increased this year, but the rates we (the State) paid for those services did not increase. Your insurance paid for increases in medical costs overall, but it also had to take on the added cost for what the State didn’t pay -- it is picking up a bit more of the unpaid Medicaid bills every year that we do not increase Medicaid payments. In the past 10 years, the amount of this cost shift has more than doubled.

This year, the House Health Care Committee is directing our Green Mountain Care Board to begin identifying exactly how much that is affecting insurance rates. Knowledge can be power. It may be more possible to make progress on this issue if people can see directly the effect these “savings” to the state budget are having on it.

Health Care Market

The biggest part of my committee’s work this year has been development of a bill to try to keep stability in the health insurance market. Whether people liked the Affordable Care Act or not (and most people liked at least some parts), changes on the federal level can affect a small market like Vermont in very negative ways, such as causing rates to spike up even faster. Our bill will try to put some of the protections of the ACA into state law, for example, coverage of pre-existing conditions, the ban on lifetime caps, and allowing young adults to stay on family policies until age 26.

The trade-off is that these protections would themselves cause increased rates unless we maximize the number of participants in the insurance pool. That means adopting the federal “shared responsibility” mandate that fines those who do not buy insurance that is affordable to them, using the roughly “eight percent of income” federal affordability test. As much as the idea of a mandate stings, the fact is that even those who think they can and will pay out-of-pocket for their own health care, use the existing infrastructure for it. And none of us can predict a severe, unaffordable illness or injury. In Vermont, you will still receive the care, but if you can’t pay, the rest of us will end up taking on the cost. Last year, private insurance rates compensated for $58 million in care for people who did not have insurance or could not pay their share.

The bill also tries to look beyond just plugging holes to continue Vermont’s efforts at equity in access to health care by asking for information to come back to us next year on a series of questions to guide further decision-making. We are down to only three percent uninsured, and want to keep it that low, but we also know that many people are under-insured: the only policies they can afford still leave major barriers to being able to afford to go to the doctor. There is a core recognition that Vermont cannot “go it alone” to create some sort of universal system – but are there other ways to move forward?

So we are asking our experts to tell us: What are the possibilities for a system where premiums are tied more directly to income? How would it be achieved? Are there ways that Vermont could adopt rate structures that other states use to help make insurance more affordable for younger persons (the highest uninsured group)? Instead of proposals that would create an entire new system for “universal primary care,” what would it cost to provide supplements to the much smaller group that does not already have strong access to primary care? If we worked with a network of states within our region, could we advance health reform initiatives that are not feasible as a single state? Having facts and data in front of us next year will be more useful than hypotheses on what we can or cannot do. We are aiming to vote this bill out on the week of the 12^th, to meet crossover.

About Minimum Wage

My time on the Health Care Committee creates a specific perspective on proposals to increase the minimum wage. I do not think they can advance without tying them to health insurance that employers are – or are not – offering, and I have introduced a bill to say that should be a requirement. It is one of the most detrimental aspects of our current health insurance system that the ability to have good coverage is so linked to where you work, and what your employer offers.

Just to illustrate, on the high end, an employer who pays the full premium for one person’s “platinum level” insurance is paying the equivalent of an additional $4.50 an hour. An employer paying $12 an hour and contributing a $3-an-hour equivalent in health benefits is actually doing better for employees than one who pays $14 an hour with no health coverage. That needs to be part of the equation, and it could even create an incentive for employers to provide better health coverage, since they receive tax benefits for the one, but not the other.

The current minimum wage increase proposals create significant risks for lost jobs and for individuals losing benefits such as child care subsidies. It also sets up scenarios such as employers cutting health benefits in order to meet new wage requirements that they cannot afford. There is a potential for a win-win-win here, as we strive to make health care accessible, living more affordable, and attract workers to Vermont. We need to keep “big picture” perspectives when we look at different initiatives such as wages, economic growth, health care, child care and all the components of quality of life.