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.

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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.

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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.

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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.