Rep.
Anne Donahue
Legislative
Update
Feb.
16, 2019
The
Appropriations Committees (House and Senate combined) will be holding hearings
on this year’s budget proposals. Unfortunately, the “community-based” hearings aren’t
very accessible to Northfield and Berlin residents. Presumably that’s because
those nearer Montpelier can come in person to the “advocate hearings,” although
those are being hosted only by the House.
The
joint hearings across the state are scheduled for Monday, Feb. 25 from 6 to 7
p.m. in Morrisville, Rutland, St. Johnsbury, St. Albans, Winooski, and
Springfield.
The
House hearings in Room 11 at the state house are this Wednesday, Feb. 20 from 1
to 2:30 p.m. regarding budget sections for the Agency of Human Services, and
Thursday, Feb. 21, 8:30 to 10 a.m. on all non-AHS sections. Although these are
listed as “advocate hearings,” meaning for advocacy group testimony, they are
open to any members of the public.
***
Budget and Health
Care
My
committee has the responsibility of making recommendations to the
Appropriations Committee on the budget areas related to health care. There are
no real “headliners” in these areas this year, but that absence is creating
concerns for us.
The
governor’s budget proposes no major program cuts, but also does little to help
address health care access and affordability or to respond to the crisis in
access to mental health care. This crisis has received a great deal of
attention because of the resulting burdens on emergency rooms that have
patients waiting for days for care, to say nothing of what it does to those
patients.
As
I discussed in my last update, we are wading our way through many sticky,
technical issues affecting the health insurance marketplace: the factors that
can impact how quickly rates can rise.
Staff
from the governor’s office presented testimony last week on some insurance
affordability ideas that could be explored over the next several years, but
would have no immediate impact.
There
is a really striking graphic that shows how unequal the current cost burdens
are. The concept that people should not have to pay more than certain
percentages of their income for health insurance falls apart rapidly for those
who are just a little bit above the level of eligibility for a subsidy.
The
subsidies are also only available to those who do not receive “affordable” employer-sponsored
coverage – but strikingly, affordable under that federal definition can
actually translate into as much as 15 percent of family income.
Single
parents or individuals can end up having to pay a higher percentage of their
income than couples if they receive a subsidy, while couples with the same
household income pay a vastly higher percentage after they are no longer
eligible. At the “cliff” when reaching 400 percent of the poverty level ($66,000
for two people), the very cheapest coverage cost $11,000 for two people, without
counting the very high co-pays included in those plans.
We
are clearly not achieving equity principles. There are at least two interesting
ideas in bills that other members have submitted and I hope we’ll take a look
at them. One would require small co-pays from those who get full coverage under
Medicaid and transfer the money for more equitable subsidies; the other would
look at what we might be able to do by teaming up with a regional multi-state
effort.
The
one budget proposal that does affect costs is one that could drive them up. Our
state regulators of hospital budgets and insurance rates get their budget
funded partially through billing those who get regulated (the hospitals and
insurance companies) and partially through state funds that are matched with
federal funds.
We’ve
got a big problem with the goose that lays our golden eggs for health care. (We
get a lot more for health care from the feds than we pay in with all our taxes –
in other words, other states subsidize us.)
We
have a deal with the federal government that allows us flexible use of matching
federal Medicaid money for a wide range of investments, as long as it stays
under a cap. The cap is based on the federal money we would have been entitled
to for regular Medicaid spending if it was not for the creative improvements we
make with that flexibility.
We’re
almost at the cap. The goose is running out of eggs. We have to prioritize
where we spend them.
So
the budget for the Green Mountain Care Board (the regulators) proposes to
reduce the state and federal funds used, and replace them by billing more to
the hospitals and insurers. The problem: our non-profit hospitals and insurance
companies don’t actually pay those bills; we do, through higher prices.
***
Turning to Mental
Health
The
Department of Mental Health issued a report to us in mid-January stressing the
need for both expansion of psychiatric inpatient beds and for more community
services to help prevent people from reaching that level of need.
The
University of Vermont Health Network is looking at a 25-bed inpatient expansion
at Central Vermont Medical Center. The DMH budget proposes only a 6-bed
expansion of supported community residences. That’s a disconnect.
There
was a lot of media last week about DMH investing $17 million more into school-based
mental health supports to help prevent later, more severe problems. That’s false
accounting. That money simply funnels through DMH from local school budgets in
order to obtain federal matching funds (part of that “flexibility” deal we
have.)
Finally,
DMH is proposing to eliminate the funding for supervision in emergency rooms
that it started supplying when the ER delays began after Irene.
I
firmly believe that all health care costs belong within our health care
reimbursement system, including Medicaid, but not funded through separate state
money that doesn’t include other insurers. That includes for mental health
care.
However,
there is one small subset of mental health care that carries a unique cost. For
about 10 percent of psychiatric admissions, the state has stepped in and
mandated health care that individuals do not request or want: involuntary care
based upon “danger to self or others.”
(Sometimes
the focus on this small number obscures the fact that most people with a mental
health care need want help, just like people with any other health care need.)
Because
it is state law that is requiring involuntary care, I think that the costs
attributed to forcing people into care – such as staffing to prevent them from leaving
the emergency room – is a uniquely state obligation. We should not be transferring
this cost to our hospitals.
***
Paid Leave, Minimum
Wage
Major
bills working through House and Senate are those to increase the minimum wage
and to create a mandatory paid leave insurance program. Balancing factor
questions: will these help attract and retain our workforce and improve
financial stability for families? Or will they stall economic growth, increase
tax burdens, reduce jobs and hurt the people they intend to help?
Those
are the debates on the imminent horizon. I am looking to what those bills will
look like when they reach the House floor, any new insights since we debated
them a year ago, and constituent input in considering what direction is in the
best interest of Vermonters.
Speaking
of “what they look like when they reach the House floor,” it is worth noting
that 800-plus bills get introduced each year, 100 or so end up being passed,
and many are never even taken up. So when you hear in the media that
such-and-such has been proposed in the legislature, it is usually premature to
either panic or rejoice.
Even
when there are reports that a bill has been passed, it usually means it has
passed either the House or the Senate – but not yet both. The deadline this
year to get through at least one body, in order to even be considered by the
other, is March 15. There are always exceptions, but generally speaking the
failure to meet this “crossover” deadline means continuation of the bill’s path
forward will be delayed at least until next year.
***
Word Games
Despite
all the weightier subjects before us, much attention this week will be on the
debate of H. 57, the abortion bill, which passed the Judiciary Committee on
Friday and is expected for debate on the House floor on Wednesday and Thursday.
It’s
had a lot of rewording, and the final version makes even more explicit what I described
previously. The bill creates no new law (or expansion of legal access) than
what has existed before; it also creates no new protection that does not
currently exist, regardless of whether Roe v Wade were to be overturned.
Does
that include the right to abortion until the moment of at least partial birth?
Yes, that’s the current status in Vermont, since we have no limitations in law.
Some argue that since such late abortions never actually happen currently, it
doesn’t matter that we are passing a law that says there is a right to access
them – a somewhat curious perspective on the rationale for passing laws.
Ultimately,
it isn’t a bill that changes anything, but it is a bill that forces legislators
to endorse the current status, or to oppose it. Since I do not endorse the
current status, I will vote no.
***
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.
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