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.

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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.

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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.

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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.

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 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.