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.
***
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.
***
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.
***
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.
***
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.
No comments:
Post a Comment