Legislative Update, Feb. 6 2016

Legislative Update

Rep. Anne Donahue

Feb. 6, 2016

 

Pity that we can’t maintain focus on the critical issues before us – the economy and budget, education and health care – instead of being distracted by whether Vermont should make marijuana legal.

This bill is not in the House yet; in fact, it hasn’t reached the Senate floor. But that’s where I’m getting questions from constituents, so:

A few years ago, I was prepared to support decriminalization (changing possession of small amounts from a crime to a small civil penalty) on three conditions: continue to consider it criminal if possession was in a school zone, enhanced penalties for possession in a motor vehicle, and a higher fine for use in public places. The bill passed with none of those, so I voted ‘no’ and was left with little confidence that there was a commitment to protecting against use by young people or against drugged driving.

I see little urgency in shifting from our current decriminalization law to endorsing it as “acceptable” (the effect of legalization.) So I currently lean against this change.  

I look forward to hearing more input from constituents.

***

The House bowed to pressure from school boards and the Senate to nearly completely repeal a bill passed less than a year ago to help slow the growth in school spending. The effect will be that towns that avoid large budget increases will take on some of the cost of those that do not. So anticipate another property tax increase that ignores local restraint.

If you heard about our midnight session to vote on this repeal, you know that even Vermont engages in political games.

Some eight years ago, I began to object to the end-of-session process of rushing final bills through without the time to even read them by suspending the usual rules and turning a three-day process into a half hour process. One of the few actual powers a minority party has is to refuse to suspend rules, because that requires a three quarter vote. So under my leadership, Republicans set out a ground rule that we would not agree to suspend rules without at least 24 hours to review it, unless there was consensus that it was a minor and non-controversial bill.

After weeks of legislative angst, last Thursday evening the Senate voted out its final bill and sent it to the House. The House Speaker scheduled it for a vote at 9:30 Friday morning. This required a rule suspension and would have left legislators with no time to even consult with their constituent towns or to assess the full fiscal implications of the Senate changes.

Democrats argued that there was great urgency because school boards had to finalize budgets by that Sunday, ignoring the reality that the window of opportunity had already passed, since budgets had already been adopted by then. There was no need to take the bill up before the next scheduled session on Tuesday.

Republicans voted against expediting the process. The Speaker kept the House in session for a revote at 3 p.m., threatening to convene the House again on Saturday. Republicans refused to bow to this bully tactic to suspend the normal process. Having been called on what may have been intended as a bluff, the Speaker had to save face and continue to maintain that it was an emergency. He reconvened the House for Saturday, which meant the Senate bill could be considered without needing to suspend rules.

Since it officially became Saturday at midnight, he set the session for 12:01 a.m. – ergo a first-ever January middle-of-the-night session. It cost tens of thousands of dollars for taxpayers, since legislators receive expenses for meals, and rooms or travel costs for the extra day.

(No, I did not put in a claim.)

Ironically, some news media reported that Republicans had tried to “delay” the bill. Last time I looked in the dictionary, refusal to suspend rules to expedite does not meet the definition of delay!

***

How can a tax that raises money from doctors save on health care costs?  It doesn’t – but it does make it possible to grab more federal tax money to pay our state spending bills, so that is the rationale of this budget proposal by the governor.

Here’s how it works:

We place a tax on providers (in this case, adding independent doctors and dentists to our existing taxes on hospitals, nursing homes and home health agencies), and take the money to spend on our Medicaid costs. Since money spent on Medicaid is matched by the federal government, we double the value of the taxes taken in.

Some of that money goes back to providers in the form of Medicaid rate increases. (Medicaid rates pay doctors at well below what it costs to deliver the care.) But they don’t necessarily get back as much as they pay in, and it could end up hurting our access to health care as doctor’s practices become unsustainable – something that has already happened in several instances in parts of northern Vermont.

As my committee delves deeper into this year’s Medicaid budget, we’re also learning more about why the budget is shooting upward.

The federal Affordable Care Act didn’t increase income levels for eligibility in terms of Vermont, because Vermont already had programs (VHAP – the Vermont Health Access Plan, and Catamount Health, a subsidy program) for lower income individuals. But it changes how income is defined, with the effect of making more people eligible. Under federal law a person’s assets (money in the bank, or the value of a home) don’t count in calculating eligibility.

It also bans access to federal subsidies for those with low income if they are now eligible for Medicaid.

So don’t frown on a neighbor who is “taking advantage” of Medicaid despite being above poverty level in income and owning a nice home and car. They have no choice but to either accept Medicaid or pay full price (tens of thousands of dollars a year) for health insurance. And we are all required to have insurance or pay a federal fine.

Through no fault of their own, these folks can end up with a real windfall, because the free benefits under Medicaid are much broader than any regular health insurance. Some of those benefits, such as dental, are optional for states to provide. Others, such as transportation to get to the doctor, are mandated by federal law.

I am pushing to explore whether we can take a middle road and cut back on some of the optional added benefits for the newly eligible, instead of making other cuts to balance the Medicaid (and overall state) budget.

Medicaid is a big deal when we look at the budget. It is 30 percent of our state spending, only a bit under education (33 percent); all other human services supports are 16 percent. Because we pull in so much federal money (coming, of course, from our federal taxes) Medicaid is only about 20 percent of all spending from money raised directly by the state. Education is 50 percent.

***

We’re also digging much deeper into the “all payer model” for health care reform. I’ll go into more detail another time, but it is not nearly as huge a deal as either feared or hoped.

Assuaging Fears: it does not change Medicare benefits. It does not turn Medicare funds over to state control. Medicare continues to be directly paid by the federal government to providers. Doctors who don’t want to be a part of new payment structures can still be paid the old way. Patients can still choose their own doctors, regardless of whether paid the new way (one payment for total care) or the old way (separate payments for each service provided.)

Lowering Hopes: it will create less cost savings than some may think. Better coordination of care and savings on doctor paperwork is likely, but other major drivers of costs will remain. Payers (the big three: Medicare, Medicaid and private insurance) will still pay their own separate rates to providers, so the cost shift – private insurance paying for what the state underpays – will not be solved. It will also add a new bureaucratic layer, because the new payment system requires that providers join an organization of multiple providers to contract for the rate and quality commitments.

***

Thanks for the honor of representing you! You can contact me or Rep. Patti Lewis by email (counterp@tds.net for me; pattijlewis@myfairpoint.net for Patti) or by leaving a message at the statehouse at 828-2228. We welcome your feedback and input.

 

January 23, 2016 Update

The effort to curb education spending increases (and thus tax increases) last year appears to be in serious jeopardy already this winter as school boards react to the “allowable growth rates” that affect the budgets now being completed.

There is a lot of misunderstanding about what the “cap” actually does, and a lot of politics surrounding the reaction.

There is a major disagreement between the House and Senate on what to do (something I think is really healthy, especially given the single-party super-majority), and very little time to act before school budgets are locked in for March town meeting voting.

I voted against Act 46 last year, not because I thought we should not push for greater consolidation of districts, but because I thought the predicted budget savings were overstated, and this alleged reform bill did little to address underlying cost and financing issues.

I believe that the “caps” were a poor, stop-gap measure to avoid any more serious efforts at reforming the financing infrastructure, but in the absence of other measures, they need to be maintained in the short term.

Why? What they do is protect districts against bearing the costs of those who are spending much more. Going above the growth rate is not banned. The limit on the growth rate varies for each school district based on prior spending. The penalty is simply that the local district must pay for its own increases in costs, instead of forcing others to pay.

The governor produced his annual budget proposal this past week, and he began by saying, “This will be my sixth budget that does not increase income, sales, or rooms and meals tax rates that are already too high.”

As pointed out in the weekly newsletter of the Vermont League of Cities and Towns, however, the governor has never included property taxes in his list of broad-based taxes that he has been unwilling to raise and therefore (appropriately) did not mention property taxes in that statement.

The state’s budget has many direct impacts on the property tax, and they cannot be left as though unrelated.

A New Distraction

As if existing controversy was not enough, a crisis erupted last week with the discovery that the Agency of Education had made an error in how it calculated the “allowable growth rate” provided to school districts. Budgets were, in some cases, based on wrong information.

The Senate had already indicated it would repeal the spending limits in Act 46, but this error became an added rationale. The Senate had opposed any spending restrictions last year, and only agreed to a compromise provision in the bill that finally passed.

The confusion resulted in the House Education Committee reconsidering its own actions, and a bill we were supposed to take up on the House floor last Tuesday was delayed. That bill proposed allowing an increase in the growth rates that would apply to all district budgets.

This means that in the coming week, the House will take up a bill with multiple components (and likely proposed amendments with lots of floor debate.) It will include the increase in growth rate, a “hold harmless” provision for the error by the Agency of Education, and potentially, a change in the limit on property tax rebates to make up for the Education Fund shortfall that will result from the allowed increase in the growth rate.

Party line politics emerged on Friday, when Republicans proposed that the House act immediately on the piece that everyone agrees on: protecting districts from negative consequences from the Agency error (the “hold harmless” provision.) That would have ensured that section passed, even if the other pieces are not addressed or the bill is voted down.

That proposal was voted down on a split between Republicans and Independents versus Democrats and Progressives.

What Is the ‘Cap’ Under Debate?

A Republican member of the House Education Committee, Scott Beck, did a superb job of explaining to his constituents the crux of this issue. Rather than duplicating his effort, I will share it directly:

“Facts can be stubborn. On average, for every additional dollar spent by a Vermont school district, their homestead taxpayers only fund half; the other half comes from homestead taxpayers in the other 276 districts through higher homestead education property tax rates. In St. Johnsbury (per pupil spending of $12,106 in FY16), $.27 of our $1.27 homestead tax rate goes to subsidize districts that spend more. In a district that spent $16,000, their homestead tax rate would have been $1.69 in FY16. If every district had spent $16,000, their tax rate would have been approximately $1.91, a $.22 subsidy.

“Given these unfortunate circumstances, it is no surprise that many school districts have spent at a rate that eclipses inflation, income growth, and grand list growth. The money comes cheap, and gets cheaper if the district spends even more. It is the equivalent of buying a compact car and paying a surcharge, while the person purchasing the full-size sedan gets a sizable discount. Even though the full-size costs more, more value is received for the money and a lot of full-size sedans leave the lot. The end result, of course, is high education property tax rates to pay for all of those full-size sedans.

“Act 46 and its allowable growth rate is intended to address at least part of this dysfunctional funding system. Prior to Act 46, if a district picked the full-size sedan, other districts that picked the compact car had to help pay for the full-size. The allowable growth rate puts an end to this practice going forward. For FY17 and FY18, the district(s) that pick the full-size sedan are going to have to pay more in the form of a penalty for exceeding their allowable growth rate.

“For those districts that cannot or will not control their education spending, this allowable growth rate probably seems unfair. They should take a moment to consider the perspective of districts that have committed to controlling their spending increases and remained within their allowable growth rate. It’s not that they don’t want any other district to be able to choose the full-size sedan, they just don’t want to have their homestead property tax rate increased to pay for it.

“What would be the result of repealing or delaying the allowable growth rate? Simple, a run on full-size sedans and homestead taxpayers up in arms over the homestead education property tax rates required to pay for them.”

How Does This Impact Us?

Many towns have a lower allowable growth rate under Act 46 than our local districts, which means that we would benefit from the greater spending reduction pressure on the higher-spending districts with lower AGRs. Without Act 46, we will continue to bear the negative impact of higher statewide spending despite our ongoing frugality.

What’s important to recognize is that Act 46 does not force any district into draconian cuts, as some folks are asserting. A decision can be made to exceed the “allowable growth rate” by whatever a district feels is necessary, and the penalty is having to pay for that extra spending from our own local property taxes, without help from the statewide education fund.

That’s a local voter decision, which affects local property taxes, as it should.

I will support any effort to “hold harmless” districts affected by the Agency of Education error, but I will not vote to repeal the Act 46 restrictions, nor to raise the thresholds.

What’s more important in the long run is that I will continue to press for an overhaul of our outdated, complex, inequitable education funding formula.

***

Thanks for the honor of representing you! You can contact me or Rep. Patti Lewis by email (counterp@tds.net for me; pattijlewis@myfairpoint.net  for Patti) or by leaving a message at the statehouse at 828-2228. We welcome your feedback and input.

January 9, 2016 Legislative Update

A new year and a new legislative session have begun, and it sounds a bit like a broken record: a mid-year budget deficit and an even bigger deficit looming for the coming fiscal year. We just keep on passing budgets that spend more than the economy is expected to grow, and should hardly be surprised by the outcome.

The chair of my Health Care Committee took a moment for reflection, nonetheless, to ground us for our work ahead, reminding us of the “extraordinary ongoing experiment in democracy” that we are participating in.

Imagine the concept, he said, of people deciding to have every town elect someone from among themselves – just another ordinary lay person without any special expertise – to send to Montpelier to try to make decisions about what is best for the town and the state.

We’ve only been trying it for a few hundred years, and it’s not a perfect system, but it’s what we’ve got and it’s better than the alternatives other folks have tried.

For the 11 of us around the table in the Health Care Committee room – six Democrats, three Republicans, one Progressive and one Independent – it was a time to remember that we share the common purpose of trying to make Vermont a better place for us all and future generations, even if we don’t agree on how to best get there.

Our Chair, Bill Lippert, suggested that in the midst of the turmoil of pressing issues of the months ahead, we keep in mind our goals and aspirations for a better system for the delivery of health care, even if they cannot or will not be achieved in the short term.

***

What are those most pressing short term issues?

Medicaid

Headlines have been telling us that a third of Vermonters are now on Medicaid, and that we hadn’t projected the size of the Obamacare increase, driving our tax burden to unsustainable levels.

That’s not fully accurate; the devil is always in the details.

About a quarter of Vermonters now have Medicaid as their primary form of health insurance. The rest of those leading to the “one third” number are those who receive some level of financial help through Medicaid for their regular health insurance: premium assistance for insurance bought through the health exchange, for example, or Medicaid as a secondary payer while on Medicare but financially needy.

Our forecasters were actually pretty accurate about how many persons would be eligible for help, but the numbers of which persons would fall into which category were off. More people were eligible for regular Medicaid as a result of both the economy (lower incomes) and the changes in federal definitions of what constitutes “income.”

Fewer ended up on premium assistance, and the cost ended up $52 million higher than expected this year. Of that, $23 million is the state’s share.

That $23 million shortfall is the largest, but not the only increase in health care spending being proposed for this mid-year adjustment to the current year’s budget. The “$1 million here, $2 million there” other increases (called “upward pressures” in government bureaucrat language) bring the total shortfall to $35 million.

That, of course, will carry forward into the needs in the budget for the year ahead.

***

All Payer Model

When the governor decided last year what some of us had known for a long time – that Vermont couldn’t go it alone to create a universal health care system – our Green Mountain Care Board began exploring other mechanisms to achieve payment reforms that would create a fairer and more sustainable way of financing our health care.

The Green Mountain Care Board was created by the legislature to lead health care reform, and this five-member board was vested with significant power to regulate hospital and private insurance rates.

Many parts of the Affordable Care Act (Obamacare) are still rolling out. Medicaid expansion was only one piece. The federal government is in particular pushing for cost containment measures for Medicare. (Refresher: Medicaid is health care funded by the state and federal government for those with low income; Medicare is the federal health insurance paid for through payroll deductions for the elderly and persons with disabilities.)

One of its tools is the “Accountable Care Organization” – ACOs – which are a lot like old managed care companies except that the management of care and costs is done by the provider organizations themselves, rather than an insurance company. Many Vermonters are not even aware that their Medicare is now being managed by an ACO.

The ACO gets paid for the Medicare services delivered, and if, through better management of patient care, it costs Medicare less than the estimate of what it would have cost otherwise, the ACO gets to split the savings with the government.

In our current payment system, care providers are paid differently by private insurance, Medicare, and Medicaid. One of the things that drive health insurance premiums up so high is that Medicaid doesn’t pay its full share of costs, so that cost is transferred to private payers, something called the “cost shift” that amounts to a hidden tax to pay for Medicaid.

The vision of the “all payer model” is for Vermont to set payment amounts for all providers: payments by Medicaid (which it already does); by private insurance (which it does indirectly, through its insurance rate-setting authority); and for Medicare (which would require federal approval, called a “waiver.”)

An ACO could then manage care for all the patients it serves without receiving different rates for different patients. The actual services a patient receives would remain controlled by existing law. In other words, if Vermont obtained a “Medicare waiver” in order to build an all-payer model, it could not touch the benefits that Medicare recipients are entitled to, but it could set the rates that are paid to the ACO.

The Achilles heel in this that isn’t discussed much is that an all payer model would mean Vermont would have to start bringing Medicaid rates up to even off into a similar range as the other two payers. Where would that money come from?

This whole idea needs a great deal of care and thought, but right now, under Vermont and federal law, the state can seek the Medicare waiver without the consent of the legislature.

Another member of the Health Care Committee – Paul Poirier, an Independent from Barre City – and I are having a bill drafted to require legislative approval before a waiver could be signed with the federal government.

This model may actually prove to be a valuable tool for payment reform, but it is full of potential pitfalls as well. We need to have the scrutiny and the confidence of much more oversight if we are going to take this plunge.

***

The Health Exchange

Much more out of the public eye these days is Vermont Health Connect, the exchange for signing up for health insurance that was such a fiasco in its first year of attempted operation.

It’s doing better, but it’s far from functioning smoothly or the way intended, and new glitches keep erupting.

One of the new “glitches” has to do with people who discover their insurance has been cancelled because they didn’t pay their premium by the due date, even after receiving a grace period.

Nothing wrong with that, it would seem.

Except that we are cashing their checks!

Usually, in business, if your check is cashed it means acceptance of a late payment.

The state says it plans on fixing this, not cashing checks if a person is being cancelled, but it isn’t a priority. There are too many other priorities – other “glitches – that are ahead of it in line.

That gives an idea of how much work is still ahead.

***

Thanks for the honor of representing you! You can contact me or Rep. Patti Lewis by email (counterp@tds.net for me; pattijlewis@myfairpoint.net  for Patti) or by leaving a message at the statehouse at 828-2228. We welcome your feedback and input.

Legislative Update, May 17, 2015

Legislative Update

May 17, 2015

Rep. Anne Donahue

 

We wrapped up the 2015 session passing a state general fund budget that was up by 4.1 percent, despite revenues that have increased only 2.4 percent. That vote came only a day after we passed an education bill that demands that schools restrain their funding to an average growth of two percent in each of the next two years.

Hypocritical? Clearly.

This update will have a lot of numbers in it, to attempt to sort some of it out. The general fund budget, as passed, rounds off to $1.469 billion. With special accounts added (including the transportation fund of $266 million), it goes to $2.354 billion. The Education Fund is $1.552 billion. The federal government contributes $1.929 billion. Thus, our total state spending budget for next year is $5.532 billion.

There were multiple variations on how to raise money. In the end, the $46.2 million in new revenue to balance the increased spending looks like this:

Income tax changes will raise $22.9 million. These will mostly affect only persons who itemize deductions from their income. Deductions will no longer be allowed for income that is spent paying state and federal taxes, and most other deductions will be capped.

The House decision to cap deductions for charitable donations and for high medical expenses, however, was reversed.

Instead, the final compromise accepted a Senate proposal on an “alternative minimum tax” of three percent for persons making more than $150,000 per year. That means that regardless of any type of deductions, the bottom line can never be less than a three percent state income tax.

Everyone will see a slight increase in the tax that is charged for items bought out of state (e.g., on the Internet), where a Vermont sales tax was not charged. This is the spot on your tax return where you can choose to pay the automatic assessment, or you can provide verification that you purchased less than that. The current rate is .10 percent. It will increase to .15 next year and .20 the year after, and then automatically increase based upon the consumer price index.

After income taxes, the next biggest revenue stream is expected to be the change in the sales tax food exemption. “Soft drinks” will no longer be considered food, and so will be subject to the regular six percent sales tax.

That is expected to raise $5.1 million for the general fund. Soft drinks have a broad definition; it’s not solely soda. They include all flavored and sweetened beverages (including artificial sweeteners) unless containing more than 50 percent juice. As a whole, taxing soft drinks will bring in $7.9 million, but a percentage of sales tax revenues go to the Education Fund, so $2.8 million of it goes to the Ed Fund.

Vending machine products will now be taxed at the same rate as restaurant meals (9 percent), which is projected to raise $1 million. A new program to garnish wages or attach bank accounts for unpaid taxes is expected to raise $2 million.

That’s the bulk of new taxes, but there is another $14.3 million in increased special funds or fees. A cigarette tax increase of 33 cents per pack will raise $3.2 million for several specific health care line items. An increase in the property transfer tax will raise $5.3 million for the water clean-up bill.

Filing fees for various court actions (filing a will in Probate Court, for example) will raise an added $.7 million for the judicial branch budget, and additional fees for agriculture and developers will bring another projected $2.1 million for the water bill. The routine increase in professional licensing and other fees will raise another $2.9 million.

The grand totals raise $30.4 million for the general fund, $2.2 for the Ed Fund, and $13.6 for specially targeted funds (including the $7.5 million water clean-up bill), making the total $46.2 million.

Is there good news in that?

Yes! The versions passed in the House totaled $55.8 million; the Senate, $50.9; so the final version was pared back slightly. The two biggest proposed increases that were eliminated were an increase in the assessment on small businesses that cannot afford to provide health insurance (the Senate proposed to raise $5.1 million with it), and the cap on charitable and medical deductions on income tax (the House income tax changes would have totaled $33.2 million in new revenue, rather than the final $22.9, as passed.)

Much was made of the report that we “closed” a budget gap of $113 million. That was based on an assumption of a much larger increase in spending. Although we reduced some of that increased spending, and increased taxes, we already are projecting a gap of $50 to $70 million in next year’s budget – assuming that we continue to spend at the same rate, and that revenues (including the new revenues sources) continue to grow at the same (lower) rate.

We can only change that trajectory by spending less or by growth in the economy as a whole. That leads to the importance of the economic development bill, which also passed on the last day of the session. It invests $425,000 in initiatives to spur growth.

 

Health Care Reform

The session began with a proposal from the governor to raise $90 million in a new employer payroll tax to fund major health care initiatives. The largest piece was a jump in Medicaid payment rates so that private insurance rates wouldn’t have to be paying for Medicaid underpayment – as they do now. The concept was flawed, but beyond that, the economy clearly could not tolerate that kind of tax increase.

That tax package proposal, however, included health care budget items that would normally have been included in the general fund budget. Leaving them out of the general fund meant two things. First, the general fund total was misleading because it did not include budget lines that would normally be included. Second, the most essential funds were placed at risk, since they were separated in a “stand alone” budget that required additional revenues.

The governor’s proposal left my committee reduced from $90 to $53 million; it left the House tax committee cut back to $20 million; and it left House Appropriations cut down to $10 million. The Senate cut it down to about $7 million, and it ended up about there. (The $3.2 in tobacco taxes is matched by federal funds.) That leaves no money invested in any reform efforts. It maintained the existing level of support for low income persons (those just above Medicaid eligibility) who purchase insurance on the Health Exchange. It provided tiny increases in some provider payments.

At the same time, we learned that Medicaid costs from use of services is “running hot” at about $15 million over budget in the current year, and projected to continue at that rate next year. That was not included in the fiscal year 2016 budget we just passed. As of this particular moment in time, tax revenues have shown a spurt upward. That, it is hoped, will cover the shortfall in the current year budget.

If we are very, very lucky, we will end up with a little bit of leftover in the current budget. If so, $5 million will be set aside first for low income heating assistance next winter, and then another $13 million will be set aside for additional Medicaid costs. (That was money that is supposed to go towards repaying the Teacher’s Retirement fund loan that we borrowed from ourselves last year… but that’s another, much longer story.)

 

Education Reform

The education bill deserves more discussion, and I will include it in a later end-of-session update. The short version is that it creates strong financial incentives to create larger school districts of at least 900 students. Since there is only one Education Fund, incentives for some means, in effect, financial penalties for those who move more slowly.

In addition, there is a spending increase threshold that averages 2 percent, but varies based upon how a school district’s per pupil cost compares to the state average. Northfield is just a hair below the state average and thus would be allowed slightly more; Berlin is a bit above, so it would be held to below 2 percent. If the threshold is exceeded, it triggers the existing excess spending penalty.

 

Childhood Immunizations

(This report was shared last week on Front Porch Forum.)

Before the final week of budget wrap-up, we had an intense debate over elimination of the philosophical exemption from required immunizations. I want to thank constituents from both sides who shared views on removal of the “philosophical exemption” from mandatory childhood immunizations. I also want to share my conclusion, which was that we had a better option for achieving the vital need to increase immunization rates. I presented a proposal for that option which was rejected by a razor-thin, 73-71 vote.

These are the comments I made in explaining my amendment on the House floor:

I grew up with a father who was deeply committed to civil rights. But he also taught us – and I did not know at the time that he was quoting a Supreme Court justice – that “your right to swing your fist ends just short of my nose.” We do not have the right to place others at risk of injury, and it is the obligation of society to protect those who are vulnerable to injury. It is clear from the medical evidence that if our levels of immunization are not high enough, other children in our day care centers or schools are placed at risk.

We also do know that throughout all of history, science has been capable of errors in what is believed at a point in time. I have deep sympathy for parents who are concerned about vaccines, despite current medical knowledge, because of my own experience with a medical treatment which was identified as being safe. After decades of research, the reports of serious adverse effect were declared to be “nonsense,” and as being based on a fringe, anti-medical minority view. I suffered severe and permanent side effects. In our state legislature, before I became a representative myself, when I testified about the need for state oversight, a medical expert testified that my perception of an adverse effect was solely based upon my underlying illness and an effort to seek attention. I continued my own research, and later met with a researcher who was a leader in the country on the treatment, and who told me about the emerging new evidence that now recognized that the effect I experienced was a rare, but actual, adverse effect resulting from that treatment. Patients today receive informed consent information about that reality.

So we need to understand what we are asking of parents. We are asking – we are mandating -- that they surrender the ability to choose what they believe to be in the best interests for the wellbeing and safety of their child – a decision that they otherwise have the right to make – in order to meet the greater good of others in society. Taking away individual rights in this way is something that we must do when necessary to protect others. In this situation, the evidence is clear that we must increase our immunization rates in this state. As a result, if this is the only way to achieve that, I support our obligation to do so.

But if there is another way to achieve that goal – in fact, to improve the likelihood of achieving that goal – without taking away the rights of parents to decide upon the best interests of their own children – then that is what we should be doing. This amendment is that other way. If this approach will increase vaccination rates, as I believe it will, it will meet the important goals of the underlying bill without interfering with that very small group of parents who would choose a different health care approach. And I believe it will be more effective in reaching that critical goal.

This amendment follows the evidence we heard in our committee that if we increase the barriers to access an exemption, it will reduce the rates of exemptions. Our own Commissioner of Health – and to be clear and not distort his position, he remains explicit that he believes we should eliminate the philosophical exemption – but he testified that the harder it is to seek exemptions, the less they will be used.

We have the evidence of that from Oregon, where in a single year, exemption requests dropped by 17 percent, based upon required use of an online module that took time to complete, and despite grandfathering those with existing exemptions. It offered an alternative of meeting with a doctor for that purpose. It only requires the process a single time. My proposal requires both the module and a consultation with a prescribing practitioner, repeated annually. It requires that a person affirm under penalty of perjury that they are following a health care practice – not just ignoring health care – that is based upon religious, moral or ethical beliefs. It thus applies to both ethical and religious beliefs.

The underlying amendment eliminates the philosophical exemption but leaves the religious exemption untouched, with merely the existing requirement of reading brief information and checking a box. We know that many parents will simply check “religious belief” instead of “philosophical objection.” Thus it is less likely to meet our common goal of increasing immunization rates.

I firmly believe in and support the importance of increasing those rates. I simply believe this is a better way to achieve it.

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Please keep sending me your thoughts and concerns – they are important to me. Contact me any time via messages at home (485-6431) or by email: counterp@tds.net. You can read my past updates on my blog site, www.representativeannedonahue.blogspot.com.

 

 

Legislative Update, May 2, 2015

As we come into the home stretch of aligning Senate and House budget and tax bills, some are beginning to reference this as the “Year of the Alligator.” There is finally recognition of the impact of multiple years of setting budgets that do not match our rate of economic growth.

When spending increases at a higher slope than revenue growth, it creates a graph shaped like an alligator’s open jaw, ready to eat us. An increase in taxes only helps for a single year if the growth rates don’t change.

The Senate has now voted on its versions of this year’s spending and tax bills, which means that the clock has begun ticking towards adjournment. The remaining decision-making will take place in the conference committees between the two bodies, and will return to us with only a straight yes or no option.

Unfortunately, the major bill that has not moved yet is the economic development bill.

***

The Health Care Bill

This past week, the House added $12 million to the budget to pay for health care costs that were left out of the general fund. This divide and conquer process was a disingenuous way of increasing the state budget as a whole. I voted against it.

It included some essential items, but the added taxes to cover it (taxing candy and soda; increasing tobacco taxes) are projected to have a zero growth rate. Thus we opened the alligator’s jaw a bit wider for future deficits.

This was a mega-bill. It rolled up multiple policy directives, spending priorities, and taxes into a single bill. Some parts were very, very good, such as ensuring a mechanism to drop development of the Vermont Health Exchange computer system and join a federal-based exchange if it is not functioning properly by this summer.

The Green Mountain Care Board is working on payment reform, including reform that brings rates from different payers in line for similar services, and I got floor support for adding two clauses to this part of the bill.

The first explicitly bans the Board from reducing or limiting any covered Medicare services in this process. The second asks the Board to assess the pros and cons of protecting independent practitioners in their ability to set their own rates for private patients.

The most controversial part of the bill was the addition of electronic cigarettes to our laws and taxes on tobacco products. E-cigarettes allow people to take in nicotine without burning tobacco. So they are just as addictive, but less damaging to health.

The vapors they emit still carry some toxins, but they disperse in the air more rapidly, unlike the long-lingering effects of tobacco smoke. The strongest objection to them has been the illusion of “safety” and the resulting potential allure to teens as a new vehicle for getting them hooked on nicotine. The counter-argument has been the value they offer to some people in quitting tobacco.

The jury is still out on how we should regulate them. Last year, my committee placed restrictions to block access by kids, but did not ban them as part of the “second hand smoke” protections related to public places.

This is the kind of issue that really needs to come through the work of a committee, with expert testimony and the time to weigh all the factors. I objected to trying to address it based purely on opinions of legislators on the House floor.

However, an effort to ask the Health Department to gather information first was defeated, 79-59. I asked for the vote to be divided solely on the additional tax, and it passed on an extraordinarily narrow vote (extraordinary partly in that it broke party lines) of 70-67.

The length of the debate, combined with multiple roll calls on segments of the bill, resulted in two 10-hour days on the floor. With all of its parts assembled, the health care budget and tax bill passed the House on an 86-57 vote.

***

Immunizations

I hardly dare say it, but my committee will be taking up the Senate initiative to attempt, again, to remove the “philosophical exemption” clause from the state’s mandatory child immunization law. “Hardly dare,” because I know how passionately people feel on both sides of this issue, and that I will be barraged with calls from around the state.

Parents can currently have their child exempted from the array of vaccinations required before entering school for medical, religious, or reasons of philosophical objection. The more children who are exempted, however, the more other children may be placed at risk.

The issue pits personal liberties against broader social protections. I cannot commit in advance to voting a particular way, but I can commit to being deeply attentive to the testimony about the risk of harm that could result from either position.

I will also fight against moving quickly on the matter. There is no need to pass this bill this year with only a cursory review. I also believe that it is essential to have a public hearing. We owe it to people to hear them out.

***

Physician-Assisted Death

Very similar issues were at play when we debated repeal of the physician-assisted suicide bill last week. The personal liberty of having one’s doctor legally permitted to write a prescription to hasten one’s death during a terminal illness is pitted against the harm to society than can result if others are placed at risk of pressure or involuntary choices.

Two years ago, the law we enacted was very different from what even proponents had introduced. In a mucky process of concessions to win votes, many of the protections against potential abuse were stripped out.

In addition, the key data-gathering elements that have given many Oregonians comfort over the years that their law is not being abused were removed.

We believe -- data is not collected; it is anecdotal -- the law has been used twice thus far in Vermont.

One organization is aggressively marketing its support services for accessing such prescriptions, and reading its website reveals a frightening mind-frame. It tells patients that if a doctor says he or she does not support the law, it is a “red flag” that they may be unwilling to offer a terminally ill patient adequate pain relief or an early referral to hospice.

That would be unethical medical practice. The group is basically suggesting that a physician’s opposition to assisted suicide amounts to a risk that they practice medicine unethically.

Furthermore, our law (unlike any other) mandates that clinicians inform any patient with a terminal illness that a prescription to hasten death is among the array of options they have for addressing their illness – whether they want the information or not.

The result has extended to an apparent misinterpretation at some nursing homes that every patient (terminally ill or not) must be informed about this option repeatedly.

I raised these concerns on the floor in debate last week, because it is evidence that we are already seeing abuses in the law.

I also proposed an amendment to remove the clinician mandate. That issue goes to the heart of whether clinician participation is voluntary and whether we want to protect Vermonters from the perception that pressure is being placed on them. My proposal was ruled “not germane” to the bill.

Another amendment proposing to expand the data we gather and restore what the House voted to establish two years ago (but was stripped in the final compromise bill) was defeated. The final vote against repeal was 60-83.

***

Please keep sending me your thoughts and concerns – they are important to me. Contact me any time via messages at the state house (828-2228), home (485-6431) or by email: counterp@tds.net. You can read my past updates on my blog site, www.representativeannedonahue.blogspot.com.

 

 

Legislative Update, April 18, 2015

Rep. Anne Donahue

Legislative Update

April 18, 2015

 

We remain in a long “calm before the storm” period in the House right now, waiting for return of the “big bills” from the Senate: new taxes; budget; education reforms; water quality. When the conference committees and debates over Senate changes begin, it will signal that we are close to the end of the session.

There are some strictly policy bills moving, however. Likely next week we will debate the proposed changes to our system of child protection, and whether we should continue our experiment with physician-prescription suicide at end-of-life.

***

Guns

This week was all about the gun bill debate. There is a strong argument, beyond anything else, that this bill is unnecessary. Once the truly offensive proposal for private sales background checks was removed in the Senate, the two remaining pieces were very narrow, and certainly less objectionable.

Do they do anything of value, apart from achieving an “important first step” (in the words of proponents) towards greater gun control in Vermont? This nose under the camel’s tent was probably the greatest concern for many.

Part one establishes a state misdemeanor crime for something that is already a felony under federal law: possession of a firearm by someone with a prior felony conviction. The bill limited this new misdemeanor crime to prior violent or drug-related felonies.

The argument in support was that the feds aren’t willing to invest time in prosecuting the federal offense when it is solely a possession violation, unrelated to bigger federal crimes.

But if a convicted violent felon is already facing a potential 10-year prison term under federal law, will a Vermont two-year maximum penalty deter illegal gun possession? Unlikely.

Vermont’s law enforcement community wanted it as an added tool for prosecutions when the proof of an underlying crime is weak. Although it is unclear whether this will prove to be a useful tool, it is hard to argue against it, and I did support that separate subpart of the bill, which passed 89-50.

Guns and Mental Illness

It would be quite a stretch to suggest that a person in the midst of a psychotic break retained a Second Amendment right to purchase or possess a gun. No one was in dispute on that issue, and a person with an active mental illness is one of the many classes of persons banned under federal law.

Federal law extends that ban to persons who have ever been court-ordered to receive treatment, no matter how many years in the past. If states send the names in to the feds, they are listed on the National Instant Criminal Background Check System. I emphasize “criminal” because the majority of these folks have never even been accused of a crime.

This ban plays into enhancing stigma, because it is contrary to fact that persons with a mental illness present no statistically greater risk of violence – despite broad public perception. According to research, a tiny sub-group of persons have an increased risk at the time they are hospitalized and for a short time after release.

The only in-depth study of the effect of listing individuals on the database found a less than one percent possible reduction of violent crime. The study noted that when violence does occur, it is often when a person has never been under any court order because the illness had never been identified or treated.

About a quarter of states, like Vermont, do not currently require names to be sent in. The rest do, but also have what is called under federal law a “Relief from Disabilities” process. A person can regain rights once they are no longer a danger as a result of symptoms of the illness.

Interestingly, a U.S. Court of Appeals ruled last December that the permanent federal ban was unconstitutional if applied to persons in a state where there is no such process available; the ban flies in the face of what we know about recovery from mental illness, and is thus blatantly and unlawfully discriminatory.

The bill before us would require the names of those under court orders to be sent to the database, but also created a “Relief from Disabilities” process. So a key issue was, did it create a process that was legitimate, or something solely “on paper” that would continue to equate to a lifetime ban?

The second critical issue was whether any potential benefit of sending names in (that less-than-one-percent chance of benefit) was offset by the significant risk that the fear of losing gun rights would deter individuals from seeking mental health help.

A study just last fall commissioned by Vermont’s Department of Mental Health reported that this was a very valid fear. Even though the law would not actually affect anyone who voluntarily seeks help, perception is often stronger than reality.

Vermont has a very significant gun violence problem in one specific way. We have a very high and increasing rate of suicide, and currently the highest rate of increase is among men between the ages of 35 and 60. Of all gun deaths in Vermont 90 percent are from suicide, not accident or criminal violence. It is a public health crisis that has been largely unrecognized… until it became argued as a justification for this bill.

The reality, however, is that these deaths are not occurring among persons who were ever under court-ordered treatment. They are occurring because the gun-owning community is part of a strong culture that believes that men should “tough it out” if they are depressed; that continues to identify mental illness as a weakness; and that is far less likely to seek out help.

These conclusions are from the same Vermont study that recognized that mandatory reporting of names could further increase the fear of seeking help. Might we save a life at some point because someone is unable to purchase a gun because they were once committed to involuntary treatment and they are now on the database?  Perhaps.

Will we lose lives because individuals are less likely to seek help if they perceive their gun rights will be at risk, and since they are persons who have never been committed, plus already own a gun, wouldn’t be attempting (or blocked from) a purchase, regardless? More probably.

It was a key reason I could not support the bill.

Beyond that, the Relief from Disabilities process it establishes is problematic in many ways. A person can apply after the state has determined that they no longer meet the criteria for a continuation of the outpatient commitment order because the state can no longer meet the test to show they are a “danger to self or others.” (The test is met even if the person is not currently a danger, but might become a danger in the near future if they discontinue treatment.)

Although at that point the person can petition a court to have Second Amendment rights restored, they bear the difficult and costly burden of proving that they are well, even though the state has already determined that the treatment order is no longer necessary.

Coincidentally, just last week the Vermont Supreme Court ruled that the state cannot continue to take away a person’s rights if it can no longer show a risk of dangerousness. That case addressed the right to be free of government intrusion on personal autonomy.

The analogy to continuing to take away other constitutional rights without the state having the burden of showing dangerousness is clear.

I need to reference a prejudice of my own. I started this session worrying that the mental illness section of this bill would sail through, because targeting those with mental illness would be the “low-hanging fruit” that was easy to support. Indeed, gun control supporters portrayed it exactly that way, in disregard of research and fact, and playing on fear.

Most of all, I thought the gun-owning community – those tough, insensitive guys – would be ready to throw that crumb to the advocates.

I was wrong. I was deeply moved by how much these folks truly understood the issues at stake and the false assumptions that are based on stigma. Discrimination against those like me who have struggled with mental illness is still prevalent in society. They recognized that, and it became a fundamental part of their objections to the bill.

In one heart-to-heart with a member of the Vermont Federation of Sportsmen’s Clubs, when I expressed my gratitude, the member answered, “Of course we get it. Many of our members are Veterans who have struggled with PTSD.”

I owe an apology to them for the assumptions I made.

When this part of the bill was added to the felony-possession section, it lost 10 additional votes, but still passed 79-60 on the first day’s vote. The final vote was 80-62.

The Gun Shop Project

There is one good thing that is coming out of this bill, and that is the awareness of the New Hampshire Gun Shop Project, and the soon-to-begin Vermont Gun Shop Project.

It is the one thing that can truly make a difference in our suicide crisis. Its genesis was a gun shop owner in New Hampshire who was distraught about the death of a person who bought a gun from him. He teamed up with gun owner groups and suicide prevention experts to develop a program of education and resource materials.

More than half the gun shops in New Hampshire now participate. It is, most importantly, a program about empowering the gun-owning community to support members who may be in crisis, as part of a caring community of friends.

I shared information about this project earlier this year with Chris Bradley of Northfield, the current president of the Federation, who enthusiastically endorsed it – and reminded me that safety is one of the fundamental objectives of the work of the Federation.

It was Chris who first testified in the Senate to explain the program, and it ended up becoming a part of the bill. It didn’t need legislation; one of its strengths is that it is a self-generated, voluntary-participation project.

But it doesn’t hurt that our Department of Mental Health will be charged with helping to gather interested parties together to coordinate its implementation in Vermont. So I am grateful that the Federation and other Vermont gun rights groups were so quick to volunteer a leadership role, and I made a little speech to that effect on the House floor Friday.

***

Please keep sending me your thoughts and concerns – they are important to me. Contact me any time via messages at the state house (828-2228), home (485-6431) or by email: counterp@tds.net. You can read my past updates on my blog site, www.representativeannedonahue.blogspot.com.

Legislative Update April 5, 2015

Legislative Update

Rep. Anne Donahue

April 5, 2015

 

Where to begin, in the list of new taxes?

None of them are smack-you-in-the-face taxes. They are the little ones that pile up from behind the scenes, but by the end of next week they will likely add up to $63 million in new revenue in order to enable more spending. When you start putting these things together, there are some obvious ironies. There have been many media sound bites that reference the deep cuts in spending this year -- $56 million from the general fund – but the general fund actually went up by $68 million in spending. The cuts were reductions from projected increases, not from the existing base.

That increase amounted to a 4.8 percent increase in the general fund. This week, however, we passed a bill to restrict school boards to stay below a 3 percent increase in their budgets. This was in response to the “call from voters” to address unsustainable tax increases. What’s good for the goose is apparently not good for the gander.

***

Lining Up the Taxes

The deficit between projected spending and projected revenues this year was $113 million. Two weeks ago the House addressed this by cutting the increased spending by $56 million, raising taxes and fees by $35 million, and using $25 million in “one time” funds. One-time funding means it is not a repeating source of revenue. It won’t be there next year, so we will start next year with that amount as a new deficit.

Most of this year’s one-time money came through paying for general fund items in the capital construction budget. Thus we deferred construction needs in order to avoid further general fund reductions, and will start the fiscal year 2017 budget with a $25 million hole. The hole will stay that “small” only if we restrain that budget’s increase to actual revenues, something we have not achieved for six years now. Thus, the cycle continues.

The new taxes in this bill came through reducing what can be included as state income tax deductions. Our current policies say that we shouldn’t count as income (thus, shouldn’t tax) the money you had to spend on paying income taxes; the money you have to spend on high medical expenses; the money you spent repaying a home mortgage or student loan; and income you receive but give away to charities.

We all have a choice of using the “standard deduction” that simply discounts a percentage of income without have to list any specific items. Those who have higher amounts of this kind of spending, however, can receive a higher deduction if they list out (“itemize”) the deductions from income. About a third of Vermonters itemize deductions. Under this bill, any money you use to pay taxes would now be taxed. You can still deduct the others, but only to the amount of two-and-a-half times what your standard deduction would have been. I voted no.

More Spending, More Taxes

In most years, our state spending is divided into four buckets: the education fund (combined statewide property tax plus income and part of the sales and other taxes); the transportation fund (mostly gas taxes and motor vehicle fees); the capital bill (major projects that are paid with long term bonds); and “everything else,” which is the general fund. This year, we have removed items that would normally be paid for in the general fund into two new special categories.

One category is increases in health care spending. If we had included this as usual as part of the general fund budget, it would have increased the deficit by that amount of spending – in this case, by another $20 million – and living within our means would have meant sorting out all of our state priorities within that single revenue and spending bucket.

The other new bucket is the water quality bill. I think there was greater justification for accounting for that separately, because it is a major new initiative to clean up our many impaired lakes and streams.

More About Water

Virtually everyone agrees that we have a crisis in our water quality. Beyond what we want for ourselves… shhhhhh… don’t let the tourists know that Vermont -- Vermont! -- has polluted lakes and streams. On top of that, we are under a threat from the federal Environmental Protection Agency that they will force us to do it their way, if we don’t do it ourselves.

The bill we passed last week focuses on all three of our big pollution contributors: farm run-off, highway and roads run-off, and run-off from the development of land. It sets a number of new standards, and includes hiring new positions for education and enforcement. The $8 million annual price tag would be covered through a wide assortment of new fees and taxes, including farm assessments, development fees, and a small increase in the property transfer tax. For the first time, small farms (not yet defined) will require certification and an annual fee.

Some of us argued that there were other places we could get the money without new taxes. Specifically, we have a large housing and conservation fund, and if saving our water quality isn’t part of conservation, I don’t know what is. We could have deferred purchasing additional conservation land while working on water cleanup. I voted for that alternative funding, but when it failed, I did vote to support the bill as a whole, taxes included.

The Coming Health Care Tax

I’ve written at length in past updates about the $56 million expanded state spending in health care that my committee passed (over my opposition), to be paid for with a payroll tax plus a 2-cent-per-ounce tax on sugar-added drinks. We were asked by the Speaker to cut the total back to $20 million, and the Ways and Means Committee was told to find that amount in new taxes. We kept the same priorities, but cut the investments back.

The shell game is such that one part of this bill now includes an item that was cut from the general fund budget! In other words, it wasn’t a cut… it was a transfer to save general fund revenue for other spending, and to move it into this “new taxes” bucket. (The item was our existing subsidy for those with low income, but above eligibility for Medicaid, to make health care more affordable for those who are buying insurance products on the exchange – something I strongly support.)

Last week, Ways and Means dropped the payroll tax, which had been the governor’s proposal; reduced the sugar-beverage tax to a half-cent-per-ounce tax and added diet soda to it; and proposed taxes on several other items and another cigarette tax increase. The sugar-tax change turns it into being just another new tax. The fight-obesity rationale that my Health Care Committee used is eliminated when the tax is lowered to a point that it won’t affect buying patterns…. and when diet soda is added. That bill is expected to be on the House floor on Thursday and Friday.

***

Education Reform

From my perspective, don’t expect anything in our education reform bill to have an impact on school taxes any time soon. If creating larger supervisory unions over time saves money, it won’t happen for a while. The proposed cap on school budgets – that spending limit that we find impossible to live by in the legislature – was deferred for a year in the bill as passed. The cap may have been unfair for some, but it would have held tax increases down.

The big problem we face in education funding is our attempt to run a statewide system, yet also allow local towns to set their own budgets. It is a combination that is unworkable, because no town can actually control its own local tax impact. Increases are driven by what every other town spends as well, and by how a town’s property value assessment is compared to others (the “common level of appraisal.”) This bill does nothing to address that core problem, and an alternative to establish regional administrative districts that would set and vote for a budget as a district – which I supported -- failed on a 37-83 vote. This was a rare year where we had momentum for fundamental change, and this bill doesn’t achieve it. I voted no.

When we debate education reform, there is always one refreshing aspect. There are no party-line divisions. The bill passed 88-55, but many votes lined up based on small or large school district representation, rather than based on Democratic, Republican or Progressive perspectives.

***

Much Yet To Come

Sitting in the House, it is easy to forget that nothing we pass is anywhere near being a “done deal.” The Senate often comes out with very different approaches. Those get resolved in a madcap process in the last week or two of the session, and the governor still has veto power. Beyond the money bills, there are many policy issues yet to be decided.

The House, last week, agreed to require “federal prevailing wages” for capital construction bids. It sounds worthy to protect construction workers, but creates two different problems: more bids will likely go to out-of-state companies (thus, counter to helping Vermont workers) and the higher costs will mean fewer projects to go out to bid.

Next week we will be debating whether to include teachers in the category of “too essential to permit strikes” (as with police and rescue services) with a bill that would ban both striking and school-board-imposed contracts.

Among the major Senate bills under review in the House are improvements to our child protection statutes, addition of gun restriction provisions to state law, and same-day voter registration.

***

 Please keep sending me your thoughts and concerns – they are important to me. Contact me any time via messages at the state house (828-2228), home (485-6431) or by email: counterp@tds.net. You can read my past updates on my blog site, www.representativeannedonahue.blogspot.com.