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.
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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.)
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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.
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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.
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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.
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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.
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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.
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