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.
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