Saturday, March 26, 2022

March 26, 2022

 

How do we deal with the vast federal funding influx related to COVID? There is a lot of rational concern about so much federal spending. This is not “federal money.” Ultimately, only people pay taxes. We will have to pay for all of this in the future, one way or another.

Should we assess those funds on that basis and consider rejecting them? That would ignore two realities. If our share among the 50 states went back to Washington, it would be divvied up among the other 49, and we would still have to join in paying it back without our share of the benefit. Plus, selfishly speaking, Vermont is a “receiving state” for federal funds. In other words, we regularly receive more federal funds back than what we pay from all our various types of federal taxation. Some of it really is “free money” – to us.

So, the legislature is eagerly and rapidly spending it. It is all time-limited, to be spent within the next several years, so we need to appropriate all the rest of this year so that the programs and projects can be completed in time. The mega-danger is that we become reliant on any of these programs continuing once the federal money is all spent. In many cases it will appear to be “program cuts” in future years, when always intended to be short-term. The state revenue projection for the next several fiscal years is not at all rosy, so this will put massive pressure on any ongoing programs.

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Money for Bridges

Berlin and even more so, Northfield, would be big winners in the federal rescue money for transportation infrastructure projects in the Transportation bill we passed in the House this week. A new (short-term!) category for federal aid is for bridges that are not on state roads. They will be paid 100% with the federal grant, with no state or town matches required. Thanks to the new aid, 19 steel truss and covered bridges were moved to an immediate priority list and will be funded 100% by the federal grant. No state match and no town match required.

Of 19 small steel truss and covered bridges statewide, Berlin has a truss bridge on the list for the coming year and Northfield will get one truss bridge and three covered bridges (the Cox Brook Road bridges.) Wow – five of the 19 statewide!

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Money for Workforce

Assuming the Senate goes along with it – which is a caveat on anything I report regarding bills that pass the House – we are investing $42 million in efforts to address our workforce crisis. There are significant pieces that local residents should watch for because of the opportunities they may provide for scholarships and loan repayments in exchange for agreeing to stay and work in Vermont. In most cases it is a year-to-year equivalence: a year of work for a year of scholarship or repayment.

Norwich was a big help in my work on the healthcare portion of the bill, which had a major focus on our nursing shortage. I coordinated our health care committee’s input to the bill, and Norwich was my “turn to” resource for the needed terms-of-art and priorities for that sector. Its School of Nursing faces the same challenges as the others in the state and we are not graduating nearly enough new nurses to meet the need but are turning away students for lack of capacity. The House bill targets the biggest barriers to increasing capacity, and Norwich will share in the new 3-year funding that will help expand it.

The testimony pointed to several key problems: nursing school faculty earn very substantially less than in clinical positions, so they are difficult to recruit.  The simulation labs that students need are very expensive to maintain, let alone expand. And nurses in the hospitals who need to supervise students in their practice work get no added salary, so it can be hard to get volunteers given their heavy work schedules. We added to each of these with some supplemental funding including $4 million in COVID-supported capital funding for the simulation labs, to be shared among our state’s nursing schools. It will help Norwich’s School of Nursing along with the others in our state.

I’m most excited about what we call the “pipeline” program. Central Vermont Medical Center was a model for a program for its staff in front line care positions, such as nursing assistants, to get nursing degrees. It was highlighted in a recent Montpelier Bridge article. Many of those employees are already committed to working in health care here, but even with a scholarship can’t access further education because they can’t give up making an income while taking college courses. CVMC gave students paid time off for classwork and is seeing success, but it took seed money from grants to get it started. The $3m in funds we set aside for this will help any health care entity, large or small, partner with a nursing school to create a package to “grow” future nurses from within existing staff.

We very much hope the Senate will keep these programs in the bill. Housing and childcare are two other major workforce barriers, but those are addressed in separate bills.

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More Big Money

It was the deadline this week to get the big money bills from the House to the Senate for their “replies” to our initiatives, so we passed the transportation bill, the capital construction bill, the education tax rate and the state operating budget. The state budget hit an all-time record of $8.1 billion, but if you remove all federal funds, our state general fund – what we pay for in state taxes – actually went down slightly from last year.

I think we are adding too many new positions and too many new councils or boards. One can vote against the bills creating them (which I have), but it is hard to vote against the entire budget and the many positive things it includes based on those disparate items that become incorporated into it. The budget passed 135-4.

Since there are clear differences in policies that the Senate wants to advance, in particular with all the extra federal money, I hesitate to identify what the House is funding, since various items will be bartered back-and-forth in later negotiations with the Senate. For example, the Senate wants to put tens of millions into funds for businesses which paid employees who had to stay home for COVID isolation requirements. That’s not in our budget, so it would have to come from a reduction in something we funded.

The Senate has already passed a bill to continue the funding of universal school meals at a price tag of roughly $40m. That program was created by the federal government during COVID but it ends this year. Although we could continue it next year with some of our other “COVID rescue” money, there is no source to continue it the year after. So, a bill making it a permanent program will put us in a future budget bind.

The House hasn’t passed that bill yet, but it reserved money from the Education Fund to pay for it for this next year. For right now, that fund has $90+ million in carryover from last year: more money raised from property taxes than anticipated to meet the school budgets. The House plan includes returning $36m to taxpayers by reducing next year’s tax rate, reserving $36m for school lunches, and using the remainder of the excess revenue for an array of educational needs.

I’m not ready to support the lunch program until all the competing demands are in front of us. Every penny spent one place is a penny not available to spend somewhere else. Keep in mind that school lunches are already funded in full or in part for low- and moderate-income students. The universal program expands coverage to everyone, which has some real benefits but also subsidizes many families who can full afford their children’s meals.

On the “as drafted by the House” money bills, I voted for the state budget, the transportation budget, the workforce bill and the capital bill, but against the education fund tax rate bill.

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A Slew of Other Bills

We had several late evenings on the floor to wrap up all the other bills that were on deadline to send to the Senate, so I’ll give some brief highlights on some major ones.

Environmental protections: I supported a bill that set goals for increasing the amount of protected natural forestland in our state. The committee accepted an amendment I offered to increase clarity in the definitions.

I opposed a bill that sets out mandates for “clean heat” and turns over all the decision-making to create the program to a state commission. Throughout repeat questioning on the floor, proponents acknowledged that we have no idea what it will cost Vermonters in their future heating bills. Not even a guesstimate. So, we are passing a large blank check, to be paid by citizens in future fees, with no control over the program design or cost impact. The bill passed 90-42.

We passed the final 10-year redistricting plan. Our Northfield-Berlin 2-seat district will remain the same. I have been grateful in watching how this process proceeds in Vermont. In many states, it is rife with politics. The focus is how to shift lines so that the party in power gains further advantages. The plan we passed had broad tri-partisan support, 129-13. Those voting no came from among different parties that felt a detrimental impact for their own constituents.

It is nearly impossible to make everyone happy when there are constitutional requirements on how the numbers must even out among representatives. When parts of the state grow or shrink, those districts must change. One example on the Senate level: Stowe has become a part of Washington County for election purposes, instead of in its home county of Lamoille. Those folks are not happy about it.

We passed a bill creating a “Truth and Reconciliation” Task Force to hear from Vermonters who have been injured from state-supported laws and policies that caused discrimination, and to consider whether there are actions we need to take to remedy harms. Truth and Reconciliation boards have been created in other states for the same purpose of listening and recognizing historical harm. In Vermont, it is in follow-up of last year’s apology for the eugenics laws that allowed the sterilization of unwanted groups of people: those in rural poverty, those with disabilities, Abenaki people, and so-called “mixed race,” including French-Canadian. The new Task Force will also hear from persons of color and any other groups that have had experiences of harm.

I helped initiate this process by starting the effort at a recognition of the harms of eugenics some ten years ago, and I support the continuing understanding of our history and what changes may still need to happen. I believed, however, the price tag for the four-year Task Force, which will add up to about $4.5m, did not need to be that high. I made several efforts to have that budget cut back. After failing in that, I did still support the bill. It passed on a 109-30 vote.

We are continuing a multi-year process of reducing the upper levels of penalties for crimes. It was frustrating – and I challenged on the floor – bill presentations that essentially hid where reductions were. An example was changing a crime with a sentence limit of 15 years into being a “Class C felony” without saying what the sentence for that was. I was kept busy on the floor trying to look each one up, and several (such as reducing the potential sentence for burglary into an occupied home) seemed too radical without the rationale being explained. So, I voted no.

I supported a similar bill the next day that reduced drug possession offense maximum sentences and shifted the focus to treatment after the bill’s presenter – who noted my vigorous complaint the day before – did give a full explanation.

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Please contact me or Rep. Ken Goslant at any time with comments or input at adonahue@leg.state.vt.us or kgoslant@leg.state.vt.us. It is an honor to represent you.

Saturday, March 12, 2022

March 12. 2022 Legislative Update

 Between last Friday and the start of this week, no fewer than 23 bills were placed on the calendar for floor action. It may be a new record, but they won’t all actually be debated yet, as many will be referred to another committee for further review first. Most often, that’s the Appropriations Committee. If a bill will create a new cost to the budget, it has to be verified that there is actually enough money to take the project on.

The bill dump is no surprise, as Friday was the deadline for the year for bills to be voted out of their primary committee. That is not a barrier for initiatives to be slipped into other, pre-existing bills or through trading between House and Senate, but it is the cutoff for following the standard route forward.

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Bills on the Move

The House agreed in an 80-35 vote to move a bill forward that makes manufacturers responsible for the costs of free collection and disposal of hazardous wastes in household goods. It’s stuff that is highly dangerous to put in our landfill.

The argument that manufacturers instead of taxpayers will now pay for this was a farce. Obviously, the cost will show up in the products. But I do believe that if we buy something that must have leftovers safely retrieved because of high risk, we who buy it should have that included in the cost Thus, I voted for it.

Even more contentious was a bill expanding the current use program to include forested land that is not being managed or farmed. This program was created to protect us from losing farmland that was being appraised at the value if developed, instead of its “current use” as a farm. This was driving some farms out of business. Keep in mind that anything that is granted a reduction in property taxes means increases to everyone else. It passed 99-40 on a roll call vote; I opposed it.

Among bills in the week ahead:

District-mate Rep. Ken Goslant will report a bill giving greater access for adoptees to get their original birth certificates. 

We’ll review authorization for “natural organic reduction” of human remains as an alternative to traditional burials and look at a ban on mercury lamps, grants for towns to change to heating systems that reduce carbon emissions, and licensing out-of-state telehealth that maintains the access that began with a waiver for COVID while also protecting consumers.

A bill updating requirements for the coming marijuana retail establishments is expected to be contentious. 

The reapportionment bill is also on the list. It preserves our current Northfield-Berlin 2-seat district.

The mega-workforce development bill will go to Appropriations first but includes all the healthcare components my committee worked on; here, the controversy will become what we can afford and what items will be the priorities when some must be pared back.

Also going to Appropriations is the “Clean Heat Standard” bill that builds on the carbon reduction goals we created last session. It passed from its committee on a 6-4-1 vote, a sure sign of divided support and major debate. Appropriations could make significant changes, so it is too early to tell what will become the key issues in dispute.

A routine bill to discontinue boards and commissions that are no longer needed had a clause added on my initiative. I heard a concern from a constituent last fall about a requirement on the state web site that anyone applying to be appointed to a board, such as advisory boards to state agencies, must consent to their tax records being turned over. I suggested that should only be required if necessary for the specific board. Most people consider their tax records to be pretty private, and the current requirement could have a real chilling effect on citizens who want to apply.

All of the House bills will go to the Senate next, where they may be adopted, tweaked, radically changed, or left to die. Any changes then must come back for House review. That is a part of the checks-and-balances of having two separate bodies assess new legislation before it goes to the governor.

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Governor Vetoes

The major “check-and-balance” is the power of the governor to veto a bill. The legislature can overturn a veto, but that requires a two-thirds vote rather than a simple majority. We are working through several of vetoes. 

Last week, on a vote of 102-47, the House overrode the Governor on allowing Brattleboro’s decision to allow 16- and 17-year-olds to vote and run for office in local elections. I was on the losing side in supporting the Governor. We are in the midst of efforts to change laws to keep criminal offenders in Family Court up to age 24. There is another bill introduced that would forbid marriage under age 18. Both are based on the immaturity of judgement of young adults. There is a bizarre double standard here.

The newest gun control bill was also vetoed, and legislative leadership knew it didn’t have the votes for an override. They negotiated a compromise with the Governor to make it acceptable. The bill, unfortunately, addressees five different topics. What remains unacceptable to me is the permission for mental health counsellors to breach confidentiality to report a high-risk individual to the police. Well-intended, but likely with an unintended consequence. People in distress simply won’t share with a therapist if they fear being reported, and we will lose interventions that could actually prevent harm to self or others. So, I will vote no, but the die is pre-cast for passage based on the compromise.

A contractor registration bill is on hold on our calendar until April while legislative leaders and the governor seek compromise.

The veto of the rental housing registry bill is playing out under another tactic. The Senate moved $20 million for housing from the budget into the registry bill. Everyone wants that federal money to move forward. Will that result in a caving-in on the registry? That is yet to be seen.

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My Committee Bills

House Health Care contributed four to the stack of bills on the calendar. One was just technical updates to some outdated language in statutes.

Another requires hospitals to adopt uniform programs for their free care versus bad debt programs. Under federal requirements, they must have these programs in place, but the state’s health care advocate came to us with a concern about how difficult it was when each hospital had different policies within our small state. The hospital association agreed it was a problem, and they worked with the advocate on language to create the same minimum standards for everyone. 

This kind of “consensus bill” – where the parties work together to present a solution – is more frequent than folks might think, because they don’t attract news media attention since they are able to move through the legislative process without controversy or debate.

We also passed a bill requiring hearing aid coverage to be added to some health insurance policies. It is extremely narrow, only affecting about three percent of insurance products or about 20,000 Vermonters. The testimony about the importance of hearing aid coverage was compelling. Most testimony about specific problems is compelling. I was the sole “no” vote on our committee. Why? 

We have an incredibly inequitable system for access to health care. The only ones who strong access are the poorest and the wealthiest folks, or those, regardless of income, who have the good fortune to work for an employer who can afford to offer insurance that is rich in benefits and has low-cost sharing. While it may make sense to ensure that very low-income Vermonters have access to dental, eye and hearing aid services, it doesn’t make sense to pick and choose which other insurance products are mandated to add benefits, particularly when so many people struggle to afford any insurance at all.

The reason we added the new hearing aid benefit for just one small group was purely because it is the only insurance group that we have full state control over. The others all have elements of federal control. As one example, there are some older Vermonters who are just over the (very low) income threshold for getting premium assistance for Medicare. They are paying as much as 20 percent of their income for the federal premium. They are not getting help with hearing aids.

We could increase premium assistance but have not chosen to. We cannot require the federal government to add hearing aid coverage, but we could create a state-run program to assist with hearing aids. We have not chosen to do so. It’s easy for us to tell an insurance company that they must contribute to hearing aids, because it doesn’t come out of the state budget. But someone does still have to pay for it, no matter how smaller that “extra” may be.

Who are these three percent? It is those businesses who buy insurance who have more than 100 employees (so they are not mandated to buy Health Exchange products) but who have not found a way, or are a bit too small, to escape state regulation by becoming self-insured. In a change in a 5-year period, 80,000 rather than 20,000 Vermonters were on these plans. Because of our choices to increase requirements, the self-insured plans went from half to two-thirds of all commercial plans and we have lost any ability to impose any controls on them. In other words, our goals backfired.

A newly imposed benefit for this small remaining group risks tipping the equity scale even further, which is why I opposed it.

Our fourth bill adds regulation to “PBMs” across all commercial insurance. What is a PBM? It’s a pharmacy benefits manager, a company that contracts with your insurance company to run your pharmacy coverage plan. The insurance companies can save a lot of money on your behalf (saving on your premium costs) by having national companies negotiate with drug manufacturers to get the best prices, because the PBMs represent a much bigger buying pool.

But how are they paid for their services? It is often through one or both of these mechanisms: They barter with drug manufacturers to be paid a rebate in exchange for putting that particular drug on the “preferred drug list” for your plan. They control which drugs you can get for a lower co-pay based on what they are getting paid by the manufacturer. Another mechanism is that they get reimbursed for the drugs by the insurer but pay the pharmacy less than what the insurer has paid them. This “price spread” is their profit.

Sometimes, your co-pay or co-insurance is actually higher than the cost of the drug, and that excess goes back as PBM profits. The pharmacies in some cases get paid less that what they have to pay to get the drugs for patients. It is an incredibly complex system of the flow of money and drug costs, and it is putting local pharmacies out of business in Vermont. In the past 10 years, we have gone from 42 to 16 independent (non-chain) pharmacies in the state. 

Our bill only begins to scratch the surface. It would eliminate the “gag clauses” that PBMs use in their contracts with pharmacies that ban your pharmacist from telling you about less expensive options. I got a big smile of relief from Northfield Pharmacy when I told them about this part. It starts the process of greater oversight and asks our Department of Financial Regulation to report back next year on the next steps we should be taking to protect access and cost for Vermonters – and to save our local pharmacies.

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Please contact me or Ken at any time with comments or input at adonahue@leg.state.vt.us or kgoslant@leg.state.vt.us. It is an honor to represent you.