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 12th, 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.
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