May 22, 2021 Legislative Update

 

Well, for better or for worse, we’re finished for this year. The final action was, as usual, next year’s budget which begins July 1. It appears to show a staggering increase from two years ago, by more than a billion dollars – an increase of more than 16%.

But that number should sound familiar – it’s roughly the amount we’re received each of the past two years in emergency federal funds. So, the “real number” is much lower, and it’s important to understand the difference between our base budget and what we call “one-time” funds.

The base budget funds all of our ongoing budget for the operations of government. It increases based upon inflationary costs, pay increases, and any new programs intended to continue in future years. One-time appropriations are those that are for single-year expenses. They can create a future pressure because people want them to continue (at an increase to the base budget), but they come with no promise that will happen.

The base budget of state funds increased by 4.5 percent this year and 5.4 percent last year, so a 10% increase in the past two years -- from $4 billion to $4.2 billion to $4.4 billion. This includes the transportation and education budgets. The full base budget also includes hefty annual federal support, much of that coming through Medicaid funding. That has increased over the past two years from $2 billion to $2.2 billion to $2.3 billion. So federal funding is about a third of our total annual budget.

The most important question to many folks is whether the full budget reflects increases in our existing taxes, or requires an increase in tax rates or through new taxes. As has been true for several years back, this year’s budget does not require additional revenues; it reflects increased revenues from our existing tax base – including the “January surprise” -- a much healthier revenue flow than what was expected with the economic impact of COVID.

We added some 19 permanent state positions this year, and despite the fact that it did not require new taxes to cover them, it does concern me. This is the first time in many years that we have added this many new permanent positions. While the costs of these are included in the final, balanced budget, it locks in that cost. If we hit future tight budgets, it adds to the angst involved in potentially laying off staff.

***

The competing needs in the state are always very difficult to balance, because there are many. No one can get every piece they want; compromises are necessary. I was comfortable with the bottom line, despite some choices I didn’t support, and I voted yes; the overall vote was unanimous. In a follow-up year-end update, I’ll list some of the key investments made through the federal rescue act funds along with other budget highlights.

I recognize some folks don’t believe any increases in the base budget should be considered, so I’m going to drill down on one example of need. The budget includes a 3% increase for our community mental health agencies. At the same time, the budget includes a 4.1% average increase to state staff. This difference happens year over year, so the disparity continues to grow more extreme. The result is that staff leave the community agencies in order to try to make a better living, and by most recent count, the agencies have 780 vacant positions.

One result is that children in mental health distress currently have a six-month wait to access counseling. Is it any surprise that their conditions get much worse? We are seeing increased numbers of children who live in our hospital emergency rooms for days, or occasionally even more than a week. The term used is “boarding.” They have a mental health crisis so severe that it needs inpatient care, and there are not enough beds. It many cases, it would have been avoided if they got care sooner.

Now there is a new impact as well. Private, for-profit businesses are opening up shop to compete for contracts with our schools for the mental health supports needed for students. Those businesses are pilfering community agency staff by paying higher salaries. They are turning around and offering contracts to schools that have less robust services, yet are more expensive.

Why would a school system choose a higher cost contract rather than through the local community agency (in our case, Washington County Mental Health)? Because the agencies have too many vacancies to supply the staff that the schools need. This downward spiral will cost more in school budgets while offering less support to students and increasing fiscal instability for our community agencies.

Salaries at community mental health agencies not eligible for federal rescue act funding. They are part of our competing base budget priorities.

***

The budget isn’t the only place with competing interests in the same bill.

Three examples from last week: The housing bill includes crucial investments in affordable housing. It also creates a state rental housing registry (with five new state positions to run it) -- onerous because the cost would be borne by landlord fees that will be passed on in rent increases. I voted against the registry but when it was merged into one bill, I voted for the bill as a whole. The housing investments were too important. That bill remains awaiting Senate action.

Similarly, the unemployment bill made essential changes to how to maintain the Trust Fund but also prevent radical increases for business. It did this by discounting last year’s layoffs from the rating system that penalizes high layoff rates. It also included important investments to build our workforce. The same bill added $100 a month to unemployment benefits once the federal supplements end. There are a number of arguments against doing this as the crisis comes to an end, but for me the other parts of the bill outweighed the dispute over that issue, so I voted in support.

In terms of the cannabis bill, last year the House unanimously accepted my proposal that we not permit advertising when the new legal market begins. Legal sales with regulation are supposed to be about reducing the illicit market and increasing user safety through having potency and product purity standards. Identified priorities in the statute include not supporting increases in use. The Senate blocked the ban and we ended up with a bill with no advertising oversight at all, instead putting the issue off for negotiation this year.

When the advertising limits bill came out this year, I proposed a narrower addition that would prohibit advertising that was specifically targeted at increasing cannabis use. This time – in fear of Senate rejection of even that – the committee voted against it and it thus lost on the House floor, even though a number of Democrats joined Republicans in support. Despite that, I voted for the bill; without it, we would move ahead with no advertising restrictions at all.

***

When off-season committees meet this summer and fall and the legislature returns next January, it will be in person. The only exception would be a return of emergency restrictions on capacity or distancing.

The resolution making that change added authority for the Joint Rules Committee to place limits on public access when legislative committees begin meeting back in the statehouse. I’m on the House Rules committee, and I objected vociferously. If we are in the statehouse, I will not abide by limits on public access.

So, it was revised into two parts. There can be conditions on public access if needed for safety, such as a face mask requirement. (Our air-handling equipment provides seriously inadequate ventilation.) However, access itself cannot be limited.

For indoor spaces, we have always had capacity limits. Public hearings, for example, often draw a large crowd that cannot safely enter the House chamber. An “overflow room” is set up, with audio-visual access. Thus, with my support, authority for limiting access for inside spaces remained in the resolution.

***

As Rep. Goslant and I return to our regular “day jobs,” we remain available for questions or assistance. You can contact me at adonahue@leg.state.vt.us or Ken at kgoslant@leg.state.vt.us. All of my legislative updates for this year – and years past – can be accessed at representativeannedonahue.blogspot.com.

May 9, 2021 Legislative Update

 Let’s see if I can “write tight” and touch on a number of the items in play in the final two weeks of the session.

I am on the House Rules Committee, and we are in the middle of grappling with how to safely return to the statehouse next January. There are a number of competing interests. If we are in person, public access must be fully open as well. We are committed to that. But long before the pandemic, it was well known that the statehouse was an unhealthy place to be – and not just because of the bills being discussed!

The old air handling system is not adequate and in fact a few years ago a major mold problem developed in one wing, which had to be vacated for repairs. Because our processes are open, small committee rooms became stuffed with people – sometimes standing room only, clearly violating fire codes. It was a running joke about these rooms being winter virus incubators, and indeed, one bug or another often spread through a committee. So even if the state as a whole is “back to normal,” we need a new normal in the statehouse that is more health-conscious.

During our “Zoom” interim, there has also been an awareness of the increased transparency of live-streaming on YouTube and having those proceeding archived for later access. It has created greater access for public testimony without folks having to drive long distances. In returning to in-person, we don’t want to lose that, but it means IT system upgrades.

Though we’ve always had open meetings, the broader access and the archives have squelched some levels of committee interaction. Casual conversation or friendly jibing in front of 10 members of the public is one thing; it is more easily misinterpreted in the harsh light of video and people feel more compelled to be circumspect in what they say. Watching what you say isn’t a good thing for brainstorming and the free flow of ideas. Forgetting to watch what you say – something easy to do when the audience is invisible – can get you in trouble.

There is now a planning report that recommends some interim knocking down of walls for more committee space but less flow space in the building, thus restrictions on in-person public access. Most people agree that this would be totally not OK. An expanded building, however, would be several years away in planning and construction.

Should we stay on Zoom longer? It really does impair many levels of the lawmaking process, and it would not be a good public message, once the state of emergency ends, to be saying “everyone can go back to work, but we aren’t safe enough to do it ourselves yet.” This debate will extend over the next months.

***

Voting

Coming up next week on the House floor will be the Senate-passed bill on making universal mail-in balloting permanent. While I do support the concept for maximizing easy voting for folks, I’m concerned about the cost trade-off. At a million dollars a pop so that people don’t have to put in a request for an absentee ballot – something that’s incredibly easy to do – it doesn’t feel like a good investment.

However, the part of the bill I’m most concerned about is the ballot correction process. The cover forms for mail-in ballots are sometimes filled out incorrectly. Some other states have a process to inform someone and allow them to correct the error instead of the ballot being trashed. This is a new work layer for town clerks, but if there is enough advance time and it just means sending out a postcard, it seems pretty reasonable.

But as often happens, our bill takes it too far. If there isn’t enough time left, the clerk is supposed to look for other ways to track the person down. And if the ballot then is sent back in with another error, the person must be contacted again, with a new chance to correct it. That last piece crosses the line of reasonableness for me, and I will be trying to get it removed from the bill. Two bites at the apple should be enough.

***

‘Juveniles’

On the same day that the House approved Brattleboro’s charter change to allow 16- and 17-year-olds to vote on local budgets and hold office, we also approved a bill to re-enforce confidentiality protections for the newly created class of juveniles who go to Family Court: those up through age 19 if it isn’t a seriously violent crime. Does this seem, er, a little bit inconsistent?

The same teens whose arrests are confidential could run for office; voters would be shielded from the information that the youth had been stealing money from the store till when voting them onto the select board. It scares me to think of select board members or voters who are mostly completely protected from increased tax rates making decisions on increasing town services. (It is solely property taxes supporting town budgets, and you can’t even sign a lease before turning 18.) The ability to consider the balance between benefits and costs to the pocketbook is seriously impaired. Bad precedent; I voted no.

As far as extending the law to increase the number of secret arrests: there was a highly troubling aspect. Police can choose to disclose the information if they believe there is a public safety issue. There are absolutely no guidelines in the bill about what that means, so Berlin and Northfield could choose to set very different standards. It also creates a huge new loophole for actions based on unrecognized implicit bias. I fought this vigorously on the House floor and it was dispiriting to have to get legislative counsel to correct multiple errors that the member reporting the bill was making. He simply wasn’t prepared to explain it. But it passed.

***

Equity and Past Harms

My committee’s health equity bill was revised slightly by the Senate but we signed off this past week and it is on its way to the governor. We used the recommended data from Vermont’s Health Department to create a new Commission to identify ways to increase equity for groups that are suffering worse outcomes because of historic biases in health care. That includes racial and ethnic groups, but also those with disabilities and those with differences in sexual orientation or gender affiliation. I am very conscious of some of these disparities as a person with a psychiatric disability. In this category, unconscious bias is called “diagnostic overshadowing.” A provider sees a medical history record, and looses focus on an unbiased assessment of the meaning of physical health symptoms. People have died from this.

Also last week, a Senate Committee passed the House resolution of apology for the state’s role in supporting eugenics in the first half of the 1900’s. It included sterilization for those deemed “unfit to procreate.” Those included people of diverse racial and ethnic backgrounds, in particular members of Abenacki tribes, as well as those in institutions for developmental or mental health disabilities. I first introduced this 10 years ago, so it was gratifying to see it finally pass.

***

Budget Issues

The budget will be a mess this year. The House and Senate have started work on aligning our two versions, and the governor is being very public about his displeasure. Members like me are on the sidelines, waiting to see what the final package looks like.

It’s a demonstration of how having too much money to spend can be more difficult to address than having too little. There are some broad disagreements on the ways to decide on the investments we should make with the one-time bonanza of federal coronavirus relief funds – even though there is a lot of conceptual agreement on most of places where it should be invested. Those include housing, broadband and small business supports.

***

Health Care

My committee is addressing policy language that the Senate included in its budget, and what recommendations we should give to our House Appropriations Committee in response.

One is easy. You may have never heard of Pharmacy Benefits Managers, PBMs for short, because they operate completely behind the scenes. They get contracts from insurance companies to negotiate deals with drug companies to save money, often in ways very damaging to independent pharmacies, such as Northfield’s. Cutting pharmacies’ tiny profit margin is where the PBMs make most of their money, and the non-negotiable contracts they create include “gag clauses” so that pharmacies are not able to tell anyone about the practices. One PBM began requiring a major new bureaucratic requirement on pharmacies this year. We – along with a number of other states – are jumping in to ban the practice.

We are also reviewing how the legislature should be involved in oversight of the state’s renegotiation of two special arrangements we have with federal health care funding. One is called the “global commitment,” a five-year agreement now up for renewal. It allows us to use Medicaid funding for new initiatives as long as we can show it is resulting in lower-than-otherwise-projected spending.

The second is the “All Payer Model,” which allows us to join the same accountable care organizations that were established through federal law to reform payment systems for Medicare, with our Medicaid program and with voluntary involvement of commercial payers. The concept is solid: if we all use the same mechanisms, we create a more uniform system and we save money. It hasn’t yet really taken off and proven itself yet. It’s a bit of chicken and egg: insurers don’t want to sign on until they see it working, but it won’t really work until enough people are signed on. That agreement is up for renewal next year. We want the two to be aligned, and we want to maximize opportunities that may result from new Biden administration policies.

***

Forensic System

I will be reporting a bill on the floor next week that will initiative a deep dive into potential reforms to our current system for addressing people who may have committed violent crimes but can’t go to trial (or are found not guilty) because of a severe mental illness. We haven’t updated it in years, and other states are well ahead of us in best practices.

There is a great deal of public fear to contend with on the subject because of public misperceptions. First, people with a mental illness do not commit violent crimes at a higher rate than any other group. There is a different perception because of how these situations are publicly reported. In fact, of all psychiatric hospital admissions in Vermont, about one half of one percent are of people accused of a crime.

When fear drives reactions, however, the second factor is that policy is sometimes based on fear and we forget we are addressing people who have not been convicted of a crime and are constitutionally entitled to the presumption of innocence.

That doesn’t mean our system doesn’t need reform, or that we can disregard public safety in regards to individuals being held in a hospital instead of prison. But it is a complex area of law that can’t be undertaken hastily. That is what will be assessed, with an eye towards revising our current laws over the next several years.

***

  It is an honor to represent you. Please contact me (adonahue@leg.state.vt.us) or Ken (kgoslant@leg.state.vt.us) anytime to share your input, ask questions, or raise concerns. My full archive of legislative updates can be found at representativeannedonahue.blogspot.com.

April 24 2021 Legislative Update

We are entering what has been promised to be the last four weeks of the session. Senate committees have passed (or will, by Monday) the big money bills for the state budget and the capital construction budget. Those will be debated in conference committees for alignment and this is the sign that the end is in sight.

I was very happy to see that the Senate made no changes to the language my health care committee wrote for the capital bill. The administration sought, and received, the authority to begin construction of a 16-bed locked facility for individuals who no longer need inpatient psychiatric care but are not yet ready – for safety reasons – to return home. While we agreed to that, our concern was the severe shortfalls in other parts of our health care system for mental health needs. We added a requirement to the bill that a statewide assessment be made for those needs along with review of whether the emergency federal infrastructure funds could be used for the highest priorities identified.

It was prescient. If you saw the WCAX report this past week, it turns out that the longstanding issue of waits in the emergency room because of a log jam in diversion programs and inpatient beds has worsened significantly. We held a hearing to focus on children caught in this limbo, bringing the administration, hospitals and parents to the table.

The update we received was staggering. Last week, there were 19 children stranded in emergency rooms across the state. Fourteen of them had been waiting between one and six days. Three had been waiting seven or more days. Yes, days – not hours.

Children in a mental health crisis so severe that they need inpatient hospitalization, waiting an average of three days each, confined to a single emergency room bay without treatment, without anywhere to go. Four hospitals reported that between 20 and 35 percent of their ER beds were being occupied by patients waiting for a transfer for admission.

I’m going to copy an excerpt from a letter I received as a submission to Counterpoint, the mental health newspaper I edit as my “day job,” because it was that letter that was the red flag that led to our committee’s hearing: “[W]hile I walked through the ER to my own room waiting for [lab] results, I could see the lines of safety workers in front of doors to other patients. The doors were half open and I could see the children, the young teens, the lost blank stares of ones who had been waiting too long for help and were instead locked in as boarders of the ER. A young girl about ten sat on a bed, her eyes wet with tears, the safety worker at the door plugged into the internet, the young girl's gaze settling on me for just a moment. She knew I was just walking by, no lift of hope, no realized dream that I could help her out of the limbo she was in.”

The language we placed in the capital bill can help ensure that the need for crisis beds for kids rise to the top of the future priority list, but it does nothing for the children waiting next week or next month. We have directed the Department of Mental Health to come back this week with an emergency response plan. If we can put up emergency hospital wings for COVID standby in two weeks’ time, surely, we can do better for our children.

***

Pensions

It isn’t news for me to tell you that our state employee and teacher’s pension funds are in crisis. This past week the House passed a bill that will begin to address it. I wasn’t happy with the bill, because it, once again, delays real action while the shortfall grows exponentially every month that it is not addressed. The bill creates a legislative task force to report back for legislative recommendations for action next January. However, because we failed to achieve any consensus on how to move forward immediately, it became the necessary next step, and I voted for it. As far as I was concerned, the one proposal that was placed on the table earlier was unacceptable. You don’t renege on commitments already made. You fix it going forward.

There was one improvement made, because a significant part of the problem has been that the investment decisions over the past decade have returned only about half the average returns in the market. The bill makes the investment board an independent commission and adds two financial experts to its ranks.

There was quite a kerfuffle over whether the task force was “stacked” against labor, and I heard concern from several constituents on this issue. It’s important to know what that argument was. The task force has six members from employee union groups (state workers, teachers, and state police), two members from the administration, one member from the Treasurer’s office, and six legislators. The only way that is “stacked” is if you count it as six versus nine, in other words, the legislators are a part of management. But they aren’t, and neither is the state Treasurer. This also is not a bargaining group. It’s a brainstorming group, to bring a proposal back to the legislature, and the overall public interest – employees and taxpayers alike, represented by the legislators – needs to be fully present.

***

Bottle Bill

I was all in favor of the bottle bill expansion until I found out what it actually included. I think most folks thought – like I – that we were expanding the deposits to include the other single-serve beverages (water, iced tea, and so forth) so often littering our byways. Come to Green Up Day on Saturday and see for yourself.

The bill passed by the House last week goes way outside of those lines. If the Senate agrees, you’ll be paying the nickel deposit on any size beverage bottle – everything but milk or local cider. That includes a gallon of OJ or the 3-quart fruit juices; wine is added in as well. The large sizes will be a nightmare for our redemption centers, but an amendment to remove the large containers failed. Ironically, the local cider exemption was added in for local farmers who would be challenged in collecting and returning those nickels, but without a thought to include other local farm-produced beverages such as iced tea or lemonade.

The other problem is that we passed our universal mandatory recycling law since the original bottle bill. Waste haulers invested in new infrastructure to handle it all. It has been so highly successful that Vermont is now the state with the highest rate of recycling in the country. If the more valuable plastics now are diverted from that recycling stream, the waste haulers can’t offset the costs of all the less cost-efficient ones, such as paper. The result will be increases in charges for recycling from your local transfer station or your pick-up service. So, you’ll pay a lot more for groceries unless you separately bring them in for redemption, and you’ll pay more for your regular recycling as well.

Taken as a whole, this could well result in a reduction in recycling -- the very opposite of the well-intended goal. That is why I ended up voting against it.

***

Literacy

It was good to be passing a bill that invests some of our federal emergency dollars in literacy education. Our kids have suffered from a year of remote learning, and literacy skills were already a problem area. But one line in the bill caught my eye: it discussed educator training in “five key areas of literacy instruction as identified by the National Reading Panel, which are phonics, phonemic awareness, vocabulary, fluency, and reading comprehension.”

I’m really hoping that the idea that phonics is a key to literacy isn’t being identified as a new idea! I went to kindergarten and first grade in the D.C. public system at a magnet school that was experimenting with a return to phonics. They found that it worked. That was 60 years ago!

I hope we’re not just returning to phonics as a key to literacy now.

***

It is an honor to represent you. Please contact me (adonahue@leg.state.vt.us) or Ken (kgoslant@leg.state.vt.us) any time for questions; you can also ask to get on my direct mailing list for these updates. Remember that you can access any of my updates from the past on my blog at representativeannedonahue.blogspot.com.

April 11, 2021 Update

The House Health Care Committee is looking at the question right now about when it is right to do something to help a whole lot of people, knowing that your action will negatively impact a few. There is very little that we can do to directly influence how people must pay for health insurance, because it is so heavily regulated by federal law. A specific part of the new American Rescue Plan Act gives us a window of opportunity, however, to help ease health care premium increases for small businesses, non-profits and municipalities next year. Understanding the opportunity gives a glimpse into the complexities of our current system of paying for health care.

I should begin by saying the most important part of ARPA for many individuals is that you stand to benefit tremendously from the increase in premium tax credits. If you currently buy health insurance as an individual, rather than through work, should be checking immediately at Vermont Health Connect to see whether you should change your plan. This is most important if you are buying a plan directly from Blue Cross/Blue Shield or MVP and receiving no tax credits.

It is highly likely that you are now eligible for some help, but it requires that you buy your plan directly through Vermont Health Connect. VHC is open right now for new enrollment in part for this reason. In addition, if you are going without insurance because it was simply unaffordable to you at full price, you may now be eligible for help. Please check!

The Deeper Dive

The first background piece about our opportunity to help small business groups is these new, increased tax credits. Regardless of my angst over the huge deficits we are taking on as a nation through the economic stimulus efforts, I strongly support the aspect regarding the new investments to help people with health care.

Another “regardless”: whether moving to some sort of universal coverage system would be a wise solution in the future or not, I think our current gross disparities in the ability of people to get coverage – which means getting access to health care itself – is unconscionable. Hardworking people making the same amount of money may pay virtually nothing, or huge percentages of their income, to get insurance. If you are very poor and eligible for Medicaid, you are in great shape. If you have a job that provides excellent benefits, you are in great shape. If for reasons outside of your control you are working for an employer who offers minimal coverage, or you are self-employed, you are in a highly inequitable position.

Ever since the Affordable Care Act passed, one such moderate income group was the folks buying their own insurance who fell “off the cliff.” Tax credits go up to 400 percent of the poverty level, and up to that point, the ACA standard was that someone should not have to pay more than about 10 percent of their income for insurance. Tax credits (and at lower incomes, premium subsidies) filled in the rest. At 400 percent, the supports were cut off, and those individuals could end up having to pay 15 or 17 or even a higher percentage of their income. You fell off a cliff.

Under ARPA (the new federal rescue plan), those credits have no cutoff. It sets about 8.5 percent of income as the “affordable” standard, and as long as the basic plan exceeds that based on your income, you can get help. That puts many folks on a more equitable footing, and the cliff is eliminated.

Small Groups

The individual market is always the most expensive. The smaller the market the higher the cost, because the risk cannot be spread out over as many individuals. The next market group is the small business market, those with fewer than 100 employees. There is a large group market as well, but very few employers are in it in Vermont (about 3% of Vermonters) because at that size, they flee to the “self-insured” market, because that is regulated solely by federal law. None of Vermont’s requirements and protections apply to that category.

Since the ACA, there has been a 40% shift of large employers to becoming self-insured, and that market is now 33% of private insurance in Vermont. Dividing the other biggest pieces of pie up, Vermont has about 25% under Medicaid, 22% under Medicare, 15% in the combined small group and individual market, and about 3% uninsured. The 15% is split about 55/45 between small group and individual.

I mentioned that the individual market is the most expensive. Vermont made a controversial policy decision at the start of the ACA, requiring small business to be combined with the individual market, called a “merged market.” This helped individuals save some money because the market was bigger.

Continued in part 2

 

Continued from Part

The savings comes at the expense of the small business group, which had to pay rates that are higher. Small business is subsidizing people who have to buy as individuals. When we did an analysis from 2018, we found that this saved about 7% of the premium cost for individuals, and cost small businesses about 5% extra. The numbers may have shifted since, but that’s the ballpark we have, to work with. It has always been unfair to do this – but the dilemma was that it would strand individuals if we “unmerged” this market, and we were blocked by federal law from spreading the cost further by including larger employers.

What Changed?

The increase in federal tax credits has changed this picture. If the individual market cost increases by 7%, the vast majority of those people will be 100% shielded from that increase because of the new credits. We can unmerge the market and reduce premiums for small businesses, non-profits, and municipalities and their employees without a negative impact on the individual market.

Wow! A win-win. Well, not 100 percent.

First, this tax credit boost only lasts for two years; it can only help small business without hurting individuals for one insurance coverage year. It does seem likely that public pressure across the country will prevent Congress from repealing this, and the small business community has testified to us that even if it is only a one-year break, it is still worth it for them.

Second, not quite everyone wins. People in the individual market who have an income high enough that results in a plan costing less than 8.5% of their income would see that 7% increase. That actually represents the actual cost within that market, but it would be a change from existing cost for them. That is estimated to be fewer than 10% of folks currently in the individual market, because most folks at this income level have robust employer coverage. (Currently, about 32% in the individual market do not receive credits or subsidies; the drop would represent the impact of the ARPA increases.)

An even smaller number of people could be hurt in a more complicated scenario from something called the “family glitch.” This is an inequity that was unintentionally created by the ACA. People cannot go to the individual market and get subsidies if they are offered employer insurance, unless that insurance is deemed “unaffordable.” Unaffordable is defined as basic coverage that would cost more than about 10% of the employee’s household income.

The glitch is that the percentage is based upon full household income, but in relation to the cost of an individual (single-person) plan. The federal administration is trying to find a way to address this glitch, but it is not clear whether it will get resolved. Thus, those folks may remain not eligible for tax credits if they go to the individual market, but might still want to, if it provides better coverage than their employer plan. If we “unmerge” the markets, that market plan would cost them that estimated 7% increase in premium. This is fewer than 300 people in Vermont, but it still means we cannot say that this change would only benefit people, and cost no one.

These two sub-groups would have to pay the actual cost of the very small individual market, without the current benefit of being subsidized by small businesses. It is still the right thing to do. The estimate is that the small group and its employees could save about $17 million in this one year. But we have to have our eyes open, and acknowledge that there will be some individuals whose premiums would go up as a result.

Other Bits of Action

A bill requiring anyone who does any project valued at more than $3,500 to sign up on a new state registry as a contractor passed the House last week. The registry ties into a slew of requirements. Picture a college kid doing a summer project for a neighbor who fails to keep the records for seven years, or doesn’t provide her email change within 30 days.

The potential penalty? A $5,000 fine. It that likely to ever happen? Of course not. But we ought not to put things in statute that we do not intend to ever happen on the premise that it’s “not likely.” I can claim direct credit for one thing. I pointed out that the bill also had a cross-citation that allowed up to a one-year jail term for failure to register. As a result, the committee amended the bill to remove that penalty.

It is an honor to represent you. Please contact me (adonahue@leg.state.vt.us) or Ken (kgoslant@leg.state.vt.us) any time for questions; you can also ask to get on my direct mailing list for these updates.

March 27, 2021

 There were many major bills on the floor in the past week and I encourage folks to contact me or Rep. Ken Goslant if you want more background on any of them. 

We have passed on to the Senate this year’s annual budget, the two-year capital construction bill, and the transportation budget. We also passed the education tax rate bill, a major economic development bill, broadband build-out, and child care support reforms. Most of these bills had my support.

There was a bombshell regarding the review of options to address the crisis in the pension for state employees and teachers. Rather than crafting a joint bill as a committee, the chair and vice-chair released a detailed proposal that uses increases in employee contributions to addresses the shortfall from past state mismanagement. 

***

The Budget

I voted for the budget with a fair amount of trepidation. The base budget of revenues and programs is balanced and reasonable. It exercises fiscal restraint, which is particularly important given the uncertainties as we pull ourselves out of a pandemic. In conjunction with the amounts for the economic development and workforce and the broadband bills, it appropriates $650 million from the new federal COVID-19 “rescue” fund.These were all solid and constrained to single-time investments – not building new programs that will then require ongoing future state budget expenditures. In addition to the items in the bills above, it includes clean water, higher education, and sate IT system investments.

My concern is that we are looking at a total federal influx of about double that -- $1.3 billion -- in money that can be spent over the next three years, and are making spending decisions on half of it without establishing a big picture on overall priorities and how the full pie should be divided up. It is a bit like spending half the money to build part your house without knowing what you need for the rest of it and whether you will have enough money left.

The base budget does include $360 million from our state funds to sustain our current pension obligations ($100 million more than what was required last year) plus – by moving the new federal money to backfill state funds -- $150 million in addition to address the current shortfall. But that is only a drop in the bucket compared to what is needed...

***

The Pension Dilemma

I share in a strong desire to ensure that we don't back off our obligations based on our (as a state) prior mismanagement with the various state and teacher pension funds that have resulted in the $5.7 billion hole. I also agree that we should avoid decisions with a long-term impact, precipitously. Addressing those points have more complexity than may appear. 

The shortfall has built up over many years due in significant part to the state’s failure to fund its obligations, but is also based on acceptance of misguided actuarial assumptions without regular review of actual performance of investments. The boards making those decisions included employee representatives and included increases in benefits over the years – and, incomprehensively, different boards made benefit decisions from those making investment decisions. Revision of that structure is part of the reforms needed. Delay in action even for a year would have a huge impact on the ongoing exponential growth of the current shortfall. 

This past week was the first time that I and our caucus members were told about the plan presented by legislative leaders, so we hope there will be a great deal more testimony and input before a decision is made by the Government Operations Committee and brought to the House floor. When it reaches the floor, I will need to make a decision about whether a proposed resolution is fair and responsible. Once it leaves the House it goes to the Senate which will be able to change it as they see fit and then negotiate that with the House; it then goes to the Governor for his decision. So, we are still at a beginning phase. 

If you or anyone you know would like to send written testimony to the Government Operations Committee regarding specifics you should do so here: testimony@leg.state.vt.us. The details on the current proposals for change can be found at the legislative web site, legislature.vermont.gov by going to the committee web page and looking under Documents, date tab for March 24, under Chris Rupe. Two public hearing were scheduled but both filled quickly. You can watch the hearings on the same committee page; click on livestream and then on the archived YouTube link for the dates of March 26 and 29.

***

Taxes: Education Fund

We voted out the base education property tax rate (the statewide one, which can shift locally based on town budget votes), which will go down next year by about 1.5 cents on the dollar. Before celebrating, we need to remember we’ve been in this place before, when costs continued to grow but tax increases were hidden because tax rates declined. Home sales are a hot market right now. The increased prices will drive up the grand list and thus revenues will increase while the rate stays the same or goes down. If your home value goes up on paper because other homes are being sold at higher prices, your taxes will go up even if the rate decreases. Increased spending doesn’t just vanish; we still pay for it.

***

More on Taxes

We also raised a tax; one that appeared to place a small burden on very wealthy folks – those buying homes worth more than $1 million -- to help out those struggling just to buy a mobile home, by expanding the current tax credit that helps them. But recall the current increases in the market. This is resulting in major increases in the existing property transfer tax revenues. The mobile home tax credit can be increased without an added tax.

The property transfer tax also applies to far more than high-end homes. It applies to purchasers of rental properties, where costs will be passed on to low income tenants. It applies to businesses, which have been hit hard by the pandemic – and those costs will be passed on to the purchasers of goods and services. This is terrible timing. I voted no. Although several moderate Democrats joined most Republicans in opposition, the tax increase passed.

***

Capital Bill

The only issue in contention in the capital bill was the construction of a new mental health facility that will replace a decrepit, temporary 7-bed building in Middlesex. The original was a set of trailers intended to last only a few years, set up after Tropical Storm Irene to replace state hospital beds that were used for a small group of patients who did not actually still need hospital-level care, but still did need a locked setting due to unresolved safety concerns. No one questioned the urgent need to replace that structure. 

The concern was about the expansion of more state, institutional beds (the new program will be 16 beds) without addressing the need for residential supports in the community for other Vermonters who are also remaining in hospitals because of lack of access to the post-hospital support they need. A shortage of community services feeds on the need to increase higher levels (and higher cost) care. Over the past ten years, utilization of hospital beds has nearly doubled, while access to community support has been stagnant. We added 12 highest-needs beds two years ago, which are just now about to open. That’s backwards, and the cost of running this new facility will suck more money away from the ability to support other Vermonters’ needs. 

My Health Care Committee, which is responsible for policy, took extensive testimony on this concern. We reached a compromise with the Institutions Committee, which is responsible for meeting the need for essential new state construction. That committee has been working for years to get this new facility built, and the construction will go forward.

Language from our committee that I drafted was added, however, to ensure flexibility in design to allow for future changes to address other needs. They also accepted policy language for a directive to the Department of Mental Health to identify community projects over the next nine months that might be able to be funded with the new federal infrastructure money. Operating costs then may be able to be addressed with the new federal bridge funding for several years, and then replaced by state funds saved as hospital levels are reduced. 

***

Remote Vote Crisis

We had our first mini-crisis with remote voting. A thunderstorm rolling through briefly locked out several members from a vote, and when one member got up to ask if there was a way he could vote afterwards, he was told that House rules barred it. 

We started on a new bill, and I jumped up (figuratively) to call a point of order. Given our unique status in functioning from home computers, I felt we needed to find a way to preserve members’ ability to vote. A path forward was found by voting to suspend our own rules to allow a revote on the bill. The Rules Committee will be meeting to review this issue more broadly. 

After all, thunderstorm season is upon us...

***

It is an honor to represent you. Please contact me (adonahue@leg.state.vt.us) or Ken (kgoslant@leg.state.vt.us) any time for questions. Remember that you can access any of my updates from the past on my blog representativeannedonahue.blogspot.com.

March 13, 2021 Update

 It’s been a busy week facing the deadline for bills to be voted out of committee if they are to be considered by the Senate this year, and these bills will be flooding the House floor for consideration in the next few weeks. Those that require money to implement must make a stop next in the Appropriations Committee, which much balance them against the overall needs and revenues of the state.

***

Votes Last Week

Two controversial bills came up for House roll call votes this past week.

First was a Montpelier charter change to allow legal residents who are not citizens to vote on local Montpelier ballot items. Vermont law doesn’t allow towns to change their own charters without approval of the legislature. I felt this was a Montpelier voter decision about voting on Montpelier issues, which is not related to any state voting issues and sets no state precedent, so I voted yes. It passed 103-39.

The second makes it explicit in law that a judge can order a person to temporarily relinquish firearms prior to a court hearing when there is a domestic violence restraining order and it appears that there is a threat. Because there is no time for a hearing in advance, it is termed an “ex parte” order: the subject does not get to appear and give their side.

The primary opposition centered on whether a constitutional right should be suspended in this way based on the routine standard used in civil cases, which is call “preponderance of the evidence,” meaning that it is more probable than not, or weighs more than 50% on the scale of certainty. The higher standard requires a showing of “clear and convincing,” and criminal convictions require “beyond a reasonable doubt.”

There are rarely topics where I believe an issue is absolute, with no balancing of rights involved. I have opposed the overwhelming majority of bills placing restrictions on Second Amendment rights because I felt the rights were impacted in a significant way and the restriction was not something that would actually help reach the public safety goal that was articulated.

 This was an instance where I felt the balance fell towards allowing a temporary removal. The existing law permits even a child being taken from a parent “ex parte” based solely on preponderance of evidence of a claimed risk. There is urgency for these emergency orders, and the suspension of a right before the hearing can occurs is brief.

The vote on the bill was 101-41. (Everything is archived on YouTube now, so if you want to see my explanation on the House floor, you can check last Thursday’s video and go in to about the 1 hour, 46 minute spot.)

***

Up Next Week

One of the bills on the calendar next week is on registration and certification of residential contractors. The purpose is to protect consumers. It applies to jobs that exceed $2,500 in cost. The registration would be mandatory; certification would be an option for those who want to be able to demonstrate to customers that they have qualifications that have been verified by the state. The registration requires a minimum level of liability coverage and the use of written contracts. 

I’m not generally in favor of the endless increase in the various occupations we put under state oversight. This bill does seem to make some sense, but it came out of the committee with a split vote, so I’ll be considering the reasons for opposition in the floor discussion.

***

Health Care Bills

My committee passed four bills for the “crossover” deadline. Three were unanimous, and one was with one vote in opposition. 

Telehealth continues to be a major factor in our continuing virtual world, but providers must be licensed in Vermont to practice here, and “practice here” includes via telehealth. We had a bill proposed to approve telehealth practice by a mental health counselor who was licensed out of state but had an existing client who moved to Vermont. It turned out that there were a lot of complicating issues, plus a question about why we shouldn’t consider all medical professionals. We rewrote the bill to create a work group that will review all the issues and recommend legislation next year.

Sometimes it seems like we punt on a lot of subjects by setting up work groups. The reality is that if we were to do reasonable due diligence on every issue, we could easily take up half a session on one bill – or need to be a year-round legislature – so this avenue often makes sense.

A second bill addressed several mental health hospitalization topics. There is a lot of focus and oversight regarding people who are held involuntarily as a “danger to self or others,” and that’s appropriate because there are serious civil liberties at issue.

That obscures the fact that 90% of people admitted for psychiatric care are there voluntarily, just like the person who has sought admission because of a heart attack or to have a baby. Vermont’s small scale, however, means that our inpatient psychiatric units are not segregated to have locked units only for involuntary patients. This bill requires informed consent, so that someone seeking admission knows in advance that they will be in a locked unit, and may be stopped from leaving if they ask for discharge and are found to be at risk to self or others – and thus subject to the involuntary hospitalization law.

***

Two With Money

 Our other two other bills will go to Appropriations first.

Dr. Dynasaur is the umbrella name for our Medicaid programs that cover children and pregnant moms from low income families. As a partially federally funded program, Medicaid is very limited in the coverage that is permitted for undocumented immigrants.

Do we want to leave children without protection (born or unborn) based on an immigration status? Note that urgent care is always provided, but we pay for it in more roundabout ways. A Mom who had no prenatal care and gives premature birth, with high costs for the preemie, will get the care. The parents might get hounded for payment but it will be swallowed up into the hospital’s “bad debt” which is then cost-shifted to everyone’s insurance premiums.

Investing in preventative care through a state-funded program is not only the humane thing to do (or, in the words of a colleague, “the Christian thing to do”), but it also saves money. About half of these folks are here legally but their full status is still being processed; most of the others are our migrant farmworker families. The estimate is that this will involve about 22 pregnancies and 100 children. Our committee was unanimous on a bipartisan basis in voting for this bill.

The second bill represents the major work of the session for our committee. 

We have been conscious for many years about the facts that there are groups of people who, on average, have significantly worse health outcomes than everyone else. COVID brought it to the forefront. The primary groups are “BIPOC” (Black, indigenous and people of color); LGBTQ, and people with disabilities.

The reasons include a wide range of historic inequities or discrimination carried over to current hidden biases, many of them listed with source citations in the bill’s findings section.  Here are just a few of the examples:

Vermont was part of the eugenics movement of the 1930s, where people were sterilized without consent because we believed they were inferior and needed to be prevented from having children. It was used against immigrants of the time (mostly French-Canadian) and those in state institutions. It was seen as a money-saver when it came to the cost of caring for future generations of those deemed to be “insane” or “imbeciles.” No group was hit as hard, though, as the Abenaki people. That deep wound at the hands of our society led to an ongoing fear and suspicion of our medical professions, and thus, less use of appropriate medical care.

Blacks held back by generations of discrimination by law face greater challenges in basic steps forward such as homeownership, better neighborhoods, or educational opportunities. With higher rates of poverty, crowded housing, environmental toxin exposures, and lack of access to healthier foods, it should not be a surprise that there are higher rates of the kinds of overlying health conditions that make any other illness – like COVID -- more severe.

There are also unrecognized biases by health providers themselves. One example is called “diagnostic overshadowing.”  It means that if a person comes in for care with the label of “mentally ill,” a provider may allow that label to overshadow the recognition of an underlying condition.

Our bill would create a broad Commission to develop standards for data collection and to make recommendations about creation of an Office of Health Equity within our Department of Health. The original bill came to us proposing the immediate creation of such an office, and I wasn’t sure that was the right direction. 

Changing the bill to bring in the voices of all those groups most affected by health disparities first is the right way to identify the best path forward on how to address them. We have an expression in the disability community: “nothing about us, without us.” In other words, don’t help us by deciding us what is best for us. Listen to us to learn what is needed.

The one committee member who voted against the bill was not opposed to its goals, but believed we should be working through existing state agencies, rather than setting up a Commission to develop a separate, new office within the Department of Health.

***

Next for Us

Our committee’s next task is not a bill; it is a recommendation we need to make to the committee that handles the budget for new construction. The Department of Mental Health wants to move ahead with a new facility that will add nine beds as it replaces an existing, 7-bed locked step-down program for current patients in our highest security level of involuntary inpatient care. It believes this is the best way to address the ongoing problem of long delays in emergency rooms for patient in a mental health crisis, because if more current patients have a place to “step down,” inpatient beds will open up.

The Department’s own reports, however, show that we also have people who stay in the hospital longer than needed because of the lack of supported community housing, nursing home beds, or group homes. The Department also reports that community crisis teams are so short-staffed that they only respond to screen emergency room patients. They have no time to fulfil their intended function, which is to respond to a person in crisis to help avoid the need to go to the hospital.

When there are limited resources at every turn, the question we need to weigh is which steps we should prioritize.

***

  It is an honor to represent you. Please contact me (adonahue@leg.state.vt.us) or Ken (kgoslant@leg.state.vt.us) anytime to share your input, ask questions, or raise concerns. My full archive of legislative updates can be found at representativeannedonahue.blogspot.com. 

February 13, 2021 Update

 

Legislative Update

February 13, 2021

Rep. Anne Donahue

 

There is often a disconnect between the bills that constituents lobby for, and the bills that actually come up for a vote. A current bill, H.81, is a good example.

For a couple of weeks, legislators have received emails from teachers about the importance of passing this bill. Many stressed this was not a bill that changed health policy, but was solely a “technical adjustment bill” to give lowest-paid school support staff a “fair shot” at negotiating health care coverage. I’m sure some of these constituents felt I gave pretty ambiguous replies: classic “politician responses” that ducked the question of whether I would support the bill. That would be a valid criticism. I said I would “keep an eye out for it and if it does move forward, I will keep your concerns in mind.” That ducked the question.

That’s because it is rare that a bill passes out of a committee in the same form that it started. If I said, “of course I’ll vote for it,” it would be disingenuous, and potentially a promise I could not keep. If a bill is not in my own committee, it isn’t possible to know the details of both sides of the issue. There is time to gain understanding of a bill before voting on the House floor, but there are hundreds of bills and those that are taken up receive hours of testimony before a committee decides on an action.

In addition, bills evolve significantly. H. 81 came out of committee with several sections that were added from a wholly different bill – one that was not at all about “technical adjustments.” The amendments change the structure of the benefits from how they were agreed upon just two years ago when statewide bargaining for teacher and support staff benefits was established. They remove the equity language that says that the percentage of premiums paid and amount of co-pays and deductibles “shall be the same for all participating employees.” In other words, different groups of school employees might now get different levels of benefits, which was exactly what the current law sought to avoid. I’d be hard-pressed to support that.

***

Audio-only Telehealth

My committee has finished its work on the question of permanently extending access to the coverage that was created during the pandemic for audio-only phone coverage for health care. All the parties (providers, insurers and patient advocates) agreed that it has proven to be of great value for people without internet access. The only dispute was whether it should continue to be paid for by insurers and patients at the same cost as other telehealth or in-person care. Lowering reimbursement could mean providers couldn’t continue to offer the options, and the advantages to patients who have transportation obstacles or difficulty in getting time off of work would also disappear.

Our committee decided to maintain the same rate for a pilot period in order to gather and review a full year’s worth of data to assess how much it is used, whether it results in increased costs, and the impact on quality. The part most important to me was working on informed consent language. Patients must be told that they have a full choice to have an in-person appointment, and that the audio visit can be charged the same as for an inpatient visit. These phone visits can only occur if they are appropriate to the type of care needed. No offering to stich a cut over the phone!

The Senate gets its bite at the apple as well, so this outcome could change.

***

Health Equity

My Health Care Committee has begun to take testimony on H. 210, which would establish an Office for Health Equity at the Department of Health to address health disparities caused by systemic biases against people based on race, ethnicity, disability or sexual orientation. There is considerable data about the impact of these disparities. I had a sister-in-law who had psychiatric disabilities and died of internal bleeding after her complaints were dismissed as being “all in her head” – after all, she was mentally ill and “we know how that is.”

COVID-19 had made the impact of disparities very public in terms of the rates among Black people, but this is also a deeply-rooted and longstanding problem. One of the most recent pre-COVID studies demonstrated an unusual twist to the impact of prejudices. Researchers were trying to figure out why whites were becoming addicted at such higher rates to opiods. What they found was that doctors were prescribing opiods less frequently to Black patients, because of broad perceptions either that Blacks had higher pain thresholds or they were more likely to abuse painkillers – neither of them accurate.

We had some tension in our committee on the first day after one member said he believed there was a problem with racism among individuals, but he did not think it was built into our systems. He asked for examples of what “systemic racism” means. The Director of the Office of Racial Equity was testifying, and she gave some illustrations, adding that “systems” were simply collections of individuals. Some other committee members chimed in. In a VT Digger article afterwards, Xusana Davis, the Director, said that while she disagreed with his comments, she appreciated that he was willing to engage in the conversation.

I believe she was underscoring where we need to go in learning from both our own experiences and that of others, and growing in understanding of exactly what it is that people mean by terms such as “systemic racism.” We may all end up being more on the same page if we allow for these conversations instead of moving into defense or attack mode. We’ve all got blind spots; we’ve all got learning curves. We need these dialogues, even if at times they get tense.

***

Remote Voting: A Major Oops

The remote world of legislating is clumsy. It is not a good way to maintain a healthy process, but it’s what we need to do for now. However, we’ve just discovered a major glitch, and will need to make some mid-course corrections.

There are three ways that votes can be taken on the House floor. Most frequent is a simple voice vote: aye or nay. The body is making a decision as a whole, so individual voices are not counted. The written journal simply indicates that the matter passed. If anyone thinks the voice vote wasn’t clear they can request a “division.” This means the vote is taken by standing up to be counted as “aye” or “nay.” Finally, there is the roll call vote: each name is called, and each individual vote is recorded. Only with a roll call vote can legislators also give an explanation of their vote on the record. A roll call vote must be requested by at least five legislators. They tend to be fairly infrequent, and used for contentious bills.

In our remote world, roll calls remain pretty much the same. Each name is called out over Zoom. Voice votes were trickier to set up. To go off mute to say aye; re-mute, and then go off mute for the nays, with a cacophony of voices that would inevitably be more scattered, appeared likely to be unwieldy. Using those little blue hands we’ve become so familiar with causes its own problems. They are invisible to the public, yet visible as individual votes to other legislators, which does not align as a voice vote equivalent.

 Last year, we developed a tech alternative using an app that allowed a remote yes/no vote on an iPad which went directly to the House Clerk to record. If your screen froze, you could send your vote in by email, or use a phone “hotline” to the Clerk’s desk, or even just ask the Speaker out loud to call your name. The Clerk gathers these and announces the tally; the temporary remote record disappears; and the decision of the full body is recorded. There are potential inaccuracies, but no more so than when someone coughs in the middle of a “live” voice vote.

Even though the official vote was an aye or nay recorded for the whole body, the news media began reporting on the “unofficial” tally announced by the Clerk. Then they started asking for the records from the app. They wanted to see how individuals voted, even though it was officially only a voice vote of the full body. But they were told, sorry: the record disappears as soon as the vote is recorded. And that is what everyone understood when we agreed last year to this entire system to legislate remotely.

Except, that information was not accurate. As a member of the Rules Committee, I just received the update that came to the Speaker. The record for the App remains in cyberspace for 180 days before it self-deletes. Even though it may be inaccurate and was not intended to make a record of individual votes, that likely makes it a public record. The probable outcome is that we’re going to have to shift to the unwieldy, messy process of mute and un-mute for up to 150 people to speak at close to the same time to record verbal ayes or nays. Oh, what fun.

***

 It is an honor to represent you. Please contact me (adonahue@leg.state.vt.us) or Ken (kgoslant@leg.state.vt.us) anytime to share your input, ask questions, or raise concerns. My full archive of legislative updates can be found at representativeannedonahue.blogspot.com.

January 29, 2021 Legislative Update

The “corona-coaster” with its steep ups and downs took on new meaning this past week in the state’s budget. Less than a year ago, we were all terrified about the financial impact of lost revenues. Six months ago, the projections were dire. Now, it seems that we’re rolling in money, thanks to our out-sized benefits from federal relief funds, which have proved to have real economic stimulus value. It doesn’t mean we are not still in deep economic crisis, with families under major stress and businesses hanging on by the skin of their teeth. It does mean we have some resources to shore up supports.

In the governor’s budget address, he stressed the need for the excess revenues – which will be very short-term – to be invested in one-time projects that put us in better shape for the future. It is wise advice, and it seems that the legislature is mostly on board (though not necessarily agreeing on which one-time projects those should be.)

If money is put into new initiatives in the base budget, when we are back on a normal economic course and the bonus money dries up, we will be facing the prospect of eliminating programs. No matter how new an initiative is, that never goes over well. Cutting back is politically challenging.

A one-time project doesn’t add to the base and can help reduce future costs. A good example is increasing investments in broadband, which is generally recognized as a key to long term economic growth and attracting new residents in younger demographics. That means the governor’s budget actually is level-funding many areas in state government while at the same time, making $210 million in one-time funding for economic recovery through investments in housing, infrastructure, broadband buildout, environmental stewardship, carbon reducing initiatives, and government modernization, among others.

There is too much to even describe in outline form in this update, but if you want a more detailed overview (with some helpful graphs included), you can see it by going to finance.vermont.gov/budget/budget-recommendations/operating-budget/fy2022 and choosing “Executive Budget Summary;” as a mere “summary” it is 41 pages long.

It is a definite concern in my Health Care Committee that nothing was referenced regarding health care funding or initiatives, not even in access to mental health supports, which we recognize will face new pressures as a result of the stress created by COVID-19. We will be reviewing our sections in detail for recommendations to the Appropriations Committee.

The biggest budget pressure point is the underfunding of our pension obligations. The state treasurer has made some suggested alterations that the legislature will have to assess. The pension funds are at a critical juncture. According to Treasurer Pearce, no action is not an option. As an example, the unfunded liability of the teachers’ retirement plan has increased from $711 million to $1.9 billion in the past 10 years. This is with the legislature devoting ever increasing general fund dollars out of the state budget to it each year, growing from $42 million in 2010 to $136 million in the current year. The state’s share is expected to go up by another $60 million to $196 million next year. These types of increases are not sustainable, with or without more tax increases. And failure to address it could jeopardize the solvency of the pension funds. That is not an option at all.

All of these decisions will play out on the House side in the next several weeks. The budget will then go to the Senate (they will, in our House opinion, gum all our work up!), then on to conference work to align the two, and to the governor. The good news is that the House Appropriations Committee is trying to expedite its review schedule, which would be in keeping with an aim to keep this session shorter than average and focused on the essentials. The session end is directly tied to completion of the budget.

This year, like last, there will be a separate bill that allocates the new round of federal relief funding. It is more targeted this time, so we will have fewer decisions to make – unless and until something happens down in Washington regarding further stimulus money.

About a decade ago, the legislature added language into statute regarding budget development and the purposes of the state budget. This is what it says:

“The State budget, consistent with Chapter I, Article 7 of Vermont's Constitution, should "be instituted for the common benefit, protection, and security of the people, nation, or community .. ." The State budget should be designed to address the needs of the people of Vermont in a way that advances human dignity and equity and in a manner that supports the population-level outcomes set forth in 3 V.S.A. § 2311.

“Spending and revenue policies will seek to promote economic well-being among the people of Vermont, and foster a vibrant economy. Integral to achieving the purpose of the State budget is continuous evaluation of the use of public funds by systems of outcome measurement based on indicators that measure success in accomplishing the purposes of the State budget.

“Spending and revenue policies will reflect the public policy goals established in State law and recognize every person's need for health, housing, dignified work, education, food, social security, and a healthy environment.

“As consistent with State law and in conjunction with the federal government, the budget will reflect support for economic development, public safety, transportation, and other infrastructure needs.

“Revenue measures shall also be based on the principles of sustainability and stability. The Administration shall develop budget and revenue proposals as part of a transparent and accountable process with direct and meaningful participation from Vermont residents.”

 Lofty goals, but worth putting in writing to try to keep at front and center of decision-making. How does accountability play out? While you can contact me or Rep. Goslant to share your opinion, you also do have a voice beyond our representational democracy. The opportunity to directly state your values and priorities is coming up next Monday in video-conference public hearings on the budget in front of the House and Senate Appropriations Committees jointly.

The two public hearings are on February 8, from 1 to 2:30 p.m. and from 6 to 7:30 p.m. via videoconference. You can sign up to testify using this online form: legislature.vermont.gov/links/public-hearing-fy22-budget, no later than this Friday, February 5. Instructions on how to access and participate in the hearing will be sent once you have signed up for the hearing. There will be time limit based on the volume of participants, likely in the range of 2–3 minutes. The public hearings will be available to watch live on YouTube at the following link: legislature.vermont.gov/committee/streaming/vermont-joint-fiscal, or on Onion River Community Access (ORCA) if you have access to it. For more information you can contact Theresa Utton-Jerman at tutton@leg.state.vt.us or Chrissy Gilhuly at cgilhuly@leg.state.vt.us or call 828-2295. Written testimony can be submitted electronically to Theresa or Chrissy through e-mail.

***

Other Notes

My Health Care Committee is currently taking up a somewhat discrete topic related to tele-health, on the specific subject of “audio-only telehealth” (translation: by phone.)

During the pandemic, insurers are paying for telehealth visits, including audio-only, as though they were in-person visits. This is under an emergency rule by state regulators for insurance plans regulated by the state, and voluntarily by other plans. (The majority of employment-based plans in Vermont are not permitted to be regulated by the state.) This has been a critical support during a time when it may not be a good idea to travel to the doctor’s office, recognizing that there are still many Vermonters who don’t have adequate internet for standard telehealth.

Insurers and providers agree that once the pandemic is over, audio-only visits will still have a place in the range of appropriate, quality health care options. Where they don’t agree is whether insurance should reimburse claims at the same rate.

Initially left out of this discussion were patients themselves, and I pushed to hear from that perspective as we finish testimony this week. The assumption has been that since this increases access (less time away from work, avoid travel obstacles, etc), health consumers will all support it.

But the question is one of cost. If you have a high co-pay, or a high deductible plan, “paying the same” isn’t a question of payment by your insurance. It’s out of your pocket. If you are choosing an audio visit, do you think there is equal value – or at least, equal trade-offs – such that it is reasonable that it cost the same as a doctor’s visit? Will you feel comfortable with insisting on an in-person visit if your provider is encouraging a phone visit?

I’d be interested in hearing your views.

***

  It is an honor to represent you. Please contact me (adonahue@leg.state.vt.us) or Ken (kgoslant@leg.state.vt.us) anytime to share your input, ask questions, or raise concerns.

January 16 2021 Legislative Update

 Legislative Update

Rep. Anne Donahue

January 16, 2021

As we start a new session staying fully on remote platforms, the extent to which good legislative process is impaired becomes even clearer. 

Last year, the sudden shift to “Zoom” meetings came after a year-and-a-half of working together in committees and on the House floor. Now, we begin a new session with new legislators who have no opportunity to first build those working relationships. 

Vermont benefits from healthy turnover in our House of Representatives, with a blend of the new ideas and energy brought by newcomers together with some “institutional knowledge” from longer-term folks like myself who can help prevent wheels from being re-invented every two years.

The newbies, however, do have a learning curve. There is a need to understand the process itself, how committees function, how bills make their way through the system. Then there is grappling with the complexities of the subject matter itself addressed by each committee.

Just ask our district’s other rep, Ken Goslant, who is so pleased to have been reappointed to the Judiciary Committee. He will be able to really dig in this year, after having gotten that first session under the belt.

I have been re-appointed as Vice-Chair of the Health Care Committee, and we are fortunate to also have the same two other members on our committee leadership team. However, of the eight rank-and-file members, five are new to the committee and four of those are first-year legislators.

The orientation process to our tangled and multi-layered health care system has barely begun, and our plate is already full with issues that demand immediate attention: updating and revising the laws we passed in response to COVID-19 last year, and responding to the midyear budget adjustment proposals (with next year’s budget just around the corner.)

Under the Zoom constraints, we’re operating with roughly half of the time in committee we would formerly have had.

And we’re already half way through January! Yikes.

***

COVID Responses

Our committee met jointly with the Human Services and Senate Health and Welfare Committees to get updates on the state’s response to the pandemic, the vaccine rollout, and the expenditure of federal emergency funds; next week we’ll hear about the new federal legislation and what opportunities it will offer the state.

We had a presentation Friday to review the bills we passed last biennium, and it was a reminder of how many pieces need follow up. The crisis in our shrinking health care workforce is a huge one.

At the same time, both House and Senate acted quickly on one new response: a bill allowing towns some alternatives for this year’s town meetings in order to maintain safety.

Our local select boards will have the option of postponing town meeting for several months or moving all issues to an Australian ballot that is mailed to every voter (as was done for November’s general election.) Funding for the mail-in option will be provided through the federal relief funds.

***

Bill Explosion

The start of a session is when there are often news media sound bites about all sorts of new “legislative initiatives” that catch the eye. Be careful not to read too much into them – or you can ask Ken or me for specifics.

The reality is that hundreds of bills are introduced at the start of each session, reflecting the individual ideas of 150 House members and 30 Senators. The vast majority will not even be taken up by the committee they are sent to, let alone make their way through the long path to the governor’s desk.

Ten have been introduced in Health Care in the first week. Last year, the session’s total was 66. Of that, our committee passed 12, but only six of those came from individual legislators rather than through our internal committee work.

Although chairs hold the decision-making authority, most take input from the full committee about priorities, and that winnows out many of the proposals. But time often is just as much a limiting factor as lack of interest, along with the “must do” work outside of bills.

One thing is likely for any efforts by our committee in addressing large scale health care reform issues – access and affordability -- this year: there won’t be the ability to take any actions. Federal law (and to an even greater extent, federal money) heavily controls our options.

In the past four years, we had a dual focus. We were monitoring the “all payer” deal with the feds that allowed us to make payment system reforms that could be aligned between Medicare, Medicaid and private insurance; that 5-year deal was one of the few mechanisms available for reform under existing federal parameters.

We also spent a lot of effort protecting the stability of Vermont’s insurance market from changes being made at the federal level.

While it is highly likely that there will be major changes in federal law under a new administration, those will not be happening in the next three months’ time. We won’t have any ability to adapt or take advantage of changes, because we won’t know the new directions, yet.

One of the biggest variables is whether a federal law is written to control what happens, superseding state law, or creates options that allow states to establish their own initiatives. 

The classic example is “ERISA,” a longstanding federal law that bars states from regulating insurance that large companies create for their own employees. Whenever Vermont creates insurance coverage requirements, they actually only affect a limited number of insurance plans.

So, we will likely be on hold this year. There is no point in investing time and energy in restructuring health care if the work will be upended in six months.

***

My Bills

Notwithstanding the above comments, we legislators do keep introducing bills in the hopes that they will gain committee attention, if not this year, then the next. 

My list this year includes three bills that continue the efforts at parity and integration of mental health into health care, and one for creation of a working group for recommendation on much-needed reforms to our laws on addressing criminal justice system interrelationships with mental illness; 

Also, along with Rep. Goslant, a bill requested by the National Guard to match federal law in protecting employment rights, and the repeat bill on the effort to have military retirement pay exempted from income tax;

Whistleblower protection for law enforcement officers (to protect against retaliation when they do as we have directed them, and report wrongdoing by colleagues); removing the sales tax exemption from candy (I don’t believe in candy as being “food,” whereas food is an essential that should be exempt);

Can you believe that some car rental contracts in Vermont ban you from using them on dirt roads? It’s buried deep in the contract, and I think consumer deserve prominent notice!

I’m also the sponsor on a bill request from the American Kidney Association to extend medical leave and insurance to cover organ donors – an example of a bill that a committee wanted to support last year, but time was the barrier.

***

Access to Your Government

The upside to our Zoom world is your new level of access to seeing what we are doing. Every committee meeting is aired live on YouTube, but also archived. Just go to the legislative web site to look up bills, floor sessions, committee agendas, and committee meetings: legislature.vermont.gov, and feel free to ask Ken or me to guide you on finding what you are looking for.

There is also a wealth of information from presentations made to committees and developed by our staff, in particular both the overviews and “deep dives” by our legislative joint fiscal office (ljfo.vermont.gov), everything from revenue updates to how much a bill will cost the state.

Just meandering through that web site is an eye-popping number of “issue briefs” and topics that may rapidly suck you in... but in a more intelligent way that the way we sometimes get sucked into Facebook posts!

Some immediate examples of resources you might want to look at: the “health care 101” presentation that we are working through as our health care committee orientation (the second topic found under: ljfo.vermont.gov/subjects/healthcare/other-health-care-issues-and-information); the COVID-19 vaccine response plan presentation (legislature.vermont.gov/committee/document/2022/15/Date/1-13-2021#documents-section); and the 2021 presentation to us on “Principles of a High Quality Tax System” (found under the tab: ljfo.vermont.gov/subjects/revenue-and-tax/friday-tax-workshops-2019-session). 

***

And Then Other Stuff

As legislators, we also spend time outside the statehouse connecting with constituents and interest groups to help identify needs – such as touching base with the Northfield Select Board last week.

Ken and I also met last week to hear from the Northfield Savings Bank about some of the impacts of COVID. That presentation included an important information tidbit to pass along:

Were you expecting an automatic bank transfer of the $600/$1200 economic stimulus money but have not seen it posted to your account yet? There is an IRS glitch that occurred that relates to people who had accounts through their tax preparers which are now closed. 

If you might be in that category, you (or anyone) can check on the status of your payment directly through the IRS website.

***

It is an honor to represent you. Please contact me (adonahue@leg.state.vt.us) or Ken (kgoslant@leg.state.vt.us) anytime to share your input, ask questions, or raise concerns.