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.