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.

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.

February 26, 2022 Legislative Update

 

We are nearly halfway through this year’s legislative session, with bill deadlines coming at the close of the week we return after the Town Meeting break. The current week is a good one for reaching out to Rep. Ken Goslant or me to talk about pending issues, since we aren’t tied up in day-long committee meetings and floor sessions.

The weeks immediately after that deadline will be the beginning of a much heavier load of floor debates on specific bills, followed by work in committees on initiatives sent over by the Senate. The state’s budget will also be coming out from the House and headed to the Senate by the end of the month.

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Health Care Committee

My committee has finished its input into the budget and workforce bills and has three initiatives we are trying to finish by the March 11 deadline.

We wrestled with a large, late-in-the-game budget request from the Green Mountain Care Board – our state’s health regulator and reform czar – for initiating several health reform projects. We’ve spent five years on the major reconfiguration of financing that was supposed to funnel the major payment resources into entities (“Accountable Care Organizations”) that would pay health providers based on health improvements and care delivery, rather than on the basis of each individual piece of service delivered. The key element was the negotiation with the federal government to align its payments from the Medicare system into this new payment system, joining with Medicaid and commercial insurers, ergo, called the “All Payer” model. We ended up with only one accountable care organization, by the name of OneCare. Those are the two names the public may have heard referenced: the All Payer model, and OneCare.

The $5 million request from the Green Mountain Care Board is a bit of a “re-set” button being pushed, though no one has quite said that. Not nearly enough insurance plans or providers have signed on to the All Payer model yet to reach a critical mass that would create real change. It is nowhere near its targets. And the 5-year agreement with the feds is nearing its end. In addition, many of our hospitals are teetering on the edge of sustainability, caught between rising cost pressures and the inability to increase revenues enough to meet them.

So, how to recalibrate?

The Board is recommending two things: First, a deep dive on the actual delivery of health care in each part of the state. It would bring everyone to the table in each regional sector to talk about priorities and how to improve outcomes. Perhaps some hospitals need to be reconfigured to best meet local needs and maintain access. Perhaps there are efficiencies in the infrastructures.  How do we best allocate resources? But the work is intended to be from the ground up, not from top-down directives. That is a $3 million process that will also involve data gathering and analysis and technical assistance to hospitals to facilitate transformation initiatives.

Second, a reframing of how we move away from the current, predominant fee-for-service model into payment based on value received. That would involve establishing fixed payment hospital budgets: they receive overall payments to achieve population outcomes, rather than for each hospital bed they fill. Designing that system and renegotiating with the feds is the purpose of the additional $2 million investment, including the costs of deeper analysis of the hospital markets and their costs and expenses.

I drafted the language to put very clear parameters of our expectations on how this process would move forward, including a report back before any changes move forward, and we included this in our budget recommendations to the Appropriations Committee.

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Health Care Workforce

We prioritized three areas as most in need of immediate investments in our recommendations to the Commerce Committee for stabilizing the healthcare workforce. Workforce shortages cut across almost every job sector, but my committee’s task was to identify responses for health care.

We have many more applicants to our in-state nursing schools each year than we have slots for, and we are desperately short of nurses. Enhancing nursing education capacity needs to be a high priority. We recommended emergency state investments in several supports for that system, each addressing a specific current barrier. We lack nursing educators; a nurse takes a huge pay cut if they move from clinical practice to teaching. We proposed grants to nursing schools for a bridge to enhance salaries. There is a lack of clinical placements for students; practicing nurses receive nothing extra if they agree to take students under their wing. We proposed grants to hospitals to add stipends. Nursing schools need sophisticated simulation laboratories for students to practice in and they lack the capital funds to upgrade and expand them. We recommended a capital grant fund. (Think of it: would you prefer a student to try their first several IV insertions on you, or on a dummy?) Norwich will be one of the direct beneficiaries if these investments are passed.

I think the most positive initiative we are seeking to fund is a grant program for seed money to start “pipeline” projects modeled on one I heard about from Central Vermont Medical Center a few years ago. It offers staff already working in front line positions the support to advance their education and careers in exchange for commitments to continue to work there. A nursing assistant, for example, can get paid time off for classroom work plus scholarship funds so that they can afford to go to school while still working and earning a salary, and graduate as a licensed practical nurse. It has been a huge success, but the health organizations need start-up funds to create these programs.

The second major priority area is in the community mental health agency system, where year after year, the state budget falls short of funding anything near the same cost of living or inflationary increases that state employees or other government services receive. The governor’s budget proposed a three percent increase this year, and we have proposed making it 10 percent instead, to help with catch-up to market salaries. We also proposed an expansion of scholarship and loan repayments for furthering education.

The third priority area is to address everything we can’t do in the first year of an emergency response, and that is to lay the groundwork for a more cohesive, long-term response. Last year, we asked for a strategic plan for this purpose. A cross-agency work group came out with no less than 40 recommendations, most of them very common sense. But someone has to actually follow-up to make them happen, to pull the players together to reduce barriers and to develop healthcare career-building at earlier points. We recommended staffing a time-limited position to implement components of the plan.

Finally, one of the recommendations in the plan was to establish a single point of information to gather data on the healthcare workforce, which will enable future supply and demand modeling to understand what needs to be targeted. We want that to be developed immediately. This year brought to the forefront the way we have been playing whack-a-mole over the past decade. One crisis pops up; we react. Another one; another reaction. We have no bigger picture of where the most pressing developing needs are – tied together with our changing demographics (read: we are getting older and needing more health care.) We must create that core data if we are to ever be able to act planfully instead of reactively.

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Healthcare Bills

We’ll be looking to wrap up three bills during the deadline week when we return.

The first is to address hearing aid coverage in health insurance plans. We’ve been receiving urgent pleas to address this issue over the past several years. It is a good illustration of how much our hands are tied when it comes to regulation of insurance plans. We’ve taken the first step of addressing coverage in plans that are offered on Vermont Health Connect for individual or small group coverage. We expect that some plans, beginning next plan year, will begin to include that option. Medicaid already covers them; Medicare does not and we can’t do a thing about that since the federal government controls it. (Some Medicare Advantage plans chip in towards the cost.) Many large employer plans are also controlled exclusively under federal law – but not all. So we will be looking into what steps we can take in that arena.

The second bill is a step forward in addressing financial assistance plans offered by hospitals in the state. Although the vast majority of Vermonters are insured, many have very high deductibles and are financially devasted by a major hospital stay. Hospitals all do have assistance plans, based on income, but they all differ. If you have your heart attack in the wrong county, all the rules – including basic eligibility – will be different. This bill seeks to bring them into more alignment.

Finally, we hope to pass a bill that will at least take the first steps in increasing the oversight of the shadowy middlemen in the sales of pharmaceuticals. They operate within an incredibly complex world of negotiating with drug manufacturers on behalf of insurance company and making some of their money by paying less to a pharmacy than what they pay for the drug. They have already been lobbying us about what an important role they play in health care delivery; that may be the surest indicator that we need to be watching them more closely.

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Take advantage of our “down time” during town meeting week by reaching out to me (adonahue@leg.state.vt.us) or Rep. Goslant (kgoslant@leg.state.vt.us) to share your concerns, priorities and ideas. We want to work for you – it is an honor representing you.

February 12, 2022 Legislative Update

 Legislative Update

Rep. Anne Donahue

Feb. 12, 2022

It’s a rare day that would see all political parties agree on a $50 million tax break, recognizing that with our current bubble of state revenue, some should be returned to the taxpayers. 

The difference of opinion this week on the House floor was which Vermonters should receive the benefits. The governor had proposed tax relief in multiple targeted areas (money spread wider, but in smaller amounts), and the Democratic majority countered with a bill that focused almost exclusively on one (a big impact for a much smaller group.)

The bill that passed mostly along party lines, 102-46, would provide an annual $1,200 tax credit for every child up to age six for every family with an income below $200,000. It extends to families with incomes above that on a scaled reduction up through $240,000. It also would increase the Social Security tax exemption threshold by $5,000.

The governor’s proposal included increases in the earned income tax credit for lower income families with children and in the childcare and dependent tax credit; tax credits for student loan repayment, first time homebuyers, nursing and childcare workers, and industry workforce shortage areas; and tax exemptions for military pensions and social security income. His proposals were not even vetted by the committee before moving this new bill, and there will be no additional revenues available to take them up later this session.

The first attempt at a floor amendment would have reduced the eligibility for the child tax credit to families under a $100,000 income. That would have also freed up money to include some of the governor’s proposals.

The chair of the tax committee argued that the tax credit was aimed at two separate issues: to help struggling, low-income families, and then for higher wage-earners, to send a message that Vermont was child-friendly and thus induce more young families to move here. This would thus also help our workforce shortage. I asked whether the committee had taken any testimony at all on evidence that such benefits actually do entice families, and the answer was, no. This rationale was purely hypothetical.

The amendment failed, however, 55-88.That meant that other proposed amendments to invest tax credits or exemptions in other areas were immediately found not germane and were blocked from being debated. I supported the initial bill on the first day of debate in the interest of keeping it moving, knowing amendments were coming. I voted against it when those efforts failed.

It is now in the Senate hands, where it might be tweaked, radically altered, or discarded. The final resolution of any configuration of tax relief will come after the House and Senate ultimately come to agreement over differences.

My district-mate, Rep. Ken Goslant, gave a vote explanation that explained the reason for opposing the bill very articulately: “Today I voted against this bill, not because I am opposed to tax relief to young families and expanding the Social Security income tax exemption. In fact, I am thrilled that we are discussing returning nearly $50m to Vermonters… and are finally talking about ways to attract more people to the State. 

“However, I voted no because I believe other tax relief proposals should be vetted and discussed before moving something of this magnitude. It is time that we pay attention to our seniors, and I believe that we can do much more on Social Security than a $5000 increase. I hope that we can continue the conversation on how to provide tax relief to as many Vermonters as possible, including military retirees, those with student loan debt, nurses, childcare workers, those with not just children but adult dependents and more.”

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Committee Work

My House Health Care Committee voted out our bill unanimously on creating a licensing process for providers who are out of state but want to offer health care to patients in Vermont via telehealth. It is now in the Ways and Means Committee to address the fee structure. 

We think it is important to maintain this access for Vermonters, but also protect against practitioners who do not meet standards of care. Permitting it was a huge benefit during COVID, but it is a bit scary to think about it being completely without oversight. 

Most of our current committee work is on reviewing budget recommendations and developing health care workforce proposals for the Commerce Committee's comprehensive workforce bill. There are many competing needs. We recognize that many parts of our economy are desperate for workforce support, but if you don't have health care providers, much of the rest isn't really going to help! 

The most severe current shortages are in nursing and in mental health providers. One clear need is to find better support to bring in nursing faculty and clinician-educators. We had large numbers of would-be nursing students turned away from our colleges’ programs last year for lack of capacity, driven by those lacks.

We also heard testimony about how access to mental health care is crumbling in the state, even as needs increase. Salaries in our mostly publicly funded community agencies are so far below other sectors that they are experiencing vacancy rates between 30 and 50 percent in some programs.

The governor has proposed some additional money in the budget for expanded mobile outreach programs. These are urgently needed, but we have to also face the question about opening new programs if salaries are too low to fill staff for existing ones.

One example is a crisis residence for children which now is closed on weekends for lack of staff. This only increases the problem of children ending up in the emergency room. The lack of inpatient beds that then results is even more children who are held waiting there for days and sometimes weeks. Yet, expanded mobile response could help divert from both of those needs.  

We have also just started work on a bill to address some of the practices of Pharmacy Benefit Managers (PBMs), which are the hidden intermediaries between pharmacies, insurers, and drug manufacturers. They have the ability to manipulate a lot of where the money flows. Our small independent pharmacies are the ones being most hurt by their practices.

***

Abortion

Proposal 5, the “personal reproductive autonomy” constitutional amendment, is now on its way to the November ballot for a vote; it will join the other proposed constitutional amendment, Proposal 2, which makes the prohibition on slavery more explicit. The final legislative vote in favor of moving it forward was 107-41.

It will place voters in an unfortunate position, because anyone who wants to protect the abortion access rights of Roe v Wade in our constitution will feel the need to vote for this amendment. However, it essentially eliminates the balancing that Roe v Wade identified between privacy rights and the right of society to have an interest in the “developing young in the uterus” in the late months of pregnancy. 

As Rep. Carl Rosenquist eloquently said, “This is not who we are,” to choose the exclusive rights of one group of people over the other. Most Vermonters support some restrictions in the third trimester and measures such as healthcare provider conscience protection, but these would likely be barred. It will also leave it to our judicial branch to interpret the undefined term “reproductive autonomy;” abortion is never directly mentioned in the language and this is intended as a much broader concept.

In my lengthy floor speech (and you can ask for a copy if you would like one) I argued that it was irresponsible of us to propose such an all-or-nothing, extreme perspective to the voters, ignoring the reasons for the deeply ethical questions that have divided people of good will both across the globe and through the centuries. I truly believe everyone in our legislature – and all Vermonters -- hold the positions they do based upon an interest in protecting human rights. But we interpret those rights under very different lenses.

I reflected on the times in the past that we have chosen to deem some lives as inferior to others with consequences now recognized as horrific: slaughter of indigenous peoples for their land; buying and selling of captives from Africa; sterilizing those we believed to be unfit to procreate. Each of those actions were deemed acceptable in their time. I quoted Eric Metaxas, author of Seven Women and the Secret of Their Greatness, who said: “Each era has the fatal hubris to believe that it has once and for all climbed to the top of the mountain and can see everything as it is, from the highest and most objective vantage point possible.”

I closed with a request to my colleagues: “Let us each have the humility to leave today a slight bit less certain that our perspective can stand the test of time.”

***

Town meeting week is just around the corner, and the legislature is in recess specifically to help provide access to constituents. It’s the best time to connect with Ken or me to discuss pending issues, ask questions or share your input. Please contact us 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.

January 30, 2022 Legislative Update

It was a frustrating week for our process of lawmaking, as several items barreled ahead without taking testimony – or after limiting the voices of people who wanted to testify.

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Guns

I do not believe any part of our constitution stands immutable when one part is in conflict with another. I will (and have) voted for restrictions on gun rights that maintain a constitutional balance and are likely to actually achieve their aims. Proposals before the legislature have rarely ever met that test, and the new one before us this past week did not either.

The core of the bill before was a proposal for $250 fine for carrying a gun into a hospital. Someone with ill intent will not be stopped by the threat of a $250 fine; those without ill intent will be stopped by existing signs that weapons are not allowed. If they ignore them, under current law they can be charged with trespass, which carries a 3-month jail term. So it was hard to see the value of this, but it came to us from the Senate and our House committee took full testimony on it.

However, the House also tacked on were several other pieces. One was a clarification that judges may order guns to be removed when issuing an emergency relief from abuse order. We passed this in the House last year, and I voted for it. We have an identified problem in Vermont regarding domestic violence and firearms and I believe this could have an impact. That bill is in the Senate, which has not acted on it, so the House committee added it to this Senate bill to try to press the Senate on it, by using the bill the Senate wants. (Not an unusual tactic in House-Senate relationships.)

The second add-on was a change to the length of time a buyer has to wait for a background check. When background checks became a requirement under the national reporting system, the three-day limit was a means to maintain pressure on the federal government to keep the system working efficiency. Most return from the federal computers in minutes. On fairly rare occasions, it takes longer than three days – so the person gets the gun without a completed check. That has been a focus of concern. About 20 states have extended the three-day limit, but not all as long as 30 days, which this bill proposes. There was little testimony demonstrating a need for a 30-day long delay in Vermont and it was not vetted under the standards that are the norm for passing legislation.

What concerned me the most was the third addition. It would create state law permitting health care providers, including mental health professionals, to breach patient-client confidentiality and alert the police if there is a “good faith” belief that the person owns or might buy a weapon to harm someone, and disclosure could lessen the danger. The purpose would be for the officer to seek an emergency order to remove any guns from the person.

Here’s the problem: if someone is struggling with destructive thoughts but knows their counsellor might turn them in to the police, are they still going to share that struggle to get help with resolving it? Will they even seek out someone to help them at all, if they know there is no assurance that it will not result in a breach of confidentiality? Current law permits (requires) disclosure if there is a specific and direct threat against another person. This change would make it very broad and permissive, with a potentially chilling effect on seeking help that would be to the greater detriment of public safety.

The committee took no testimony at all on this issue. That’s downright reckless. I spoke against it and supported a motion to send the bill to the Health Care Committee for review – Rep. Ken Goslant shared the concern and joined in the effort – but it was defeated on a 90-55 roll call vote. We both voted against this conglomerate bill.

***

Listening on Abortion

More barreling forward without listening came in last week’s public hearing on the proposal 5 constitutional amendment regarding abortion, where the committee’s leadership structured the hearing in a way that it limited alternative voices. In an effort at balance, the longstanding, established process for hearings on contentious differences is to have two signup sheets – a pro and a con – outside the hearing room, available a few hours in advance. A time limit for speaking is based upon the anticipated number of those coming to testify. Speakers are called on in the order they signed up but alternating between pro and con. If more of one side has signed up, the remainder are then heard until the end of the hearing.

This time, the leadership chose to limit the list to the first 70 people to signup, regardless of which position they listed. There was a Zoom versus in-person option to speak, but either one required advance signup online. By Monday morning – 2 ½ days before the Wednesday evening hearing – the cap was met, and the signup link was removed. There was no way to know how many were turned away or what positions they held. The hearing lasted well under two hours.

The Human Services Committee then voted the proposal out of committee the next morning.

***

More on Abortion

I’ve been receiving emails from constituents on both sides of the proposed constitutional amendment, and I recognize the passion abortion issues arouse. Polls show that a majority in our state support the balancing that was involved in the Roe v Wade decision, which identifies a constitutional right in the privacy interest of women as being particularly compelling in the earlier months of a pregnancy while also recognizing a legitimate state interest in the emerging life in the womb by the time of the third trimester.

The proposed Vermont constitutional amendment instead proposes one radical extreme, barring any state intervention at any time during a pregnancy up until birth. It also uses an undefined term – “reproductive autonomy” – which allows for multiple future unforeseeable court interpretations. Abortion is never directly referenced in the language.

On a personal level, I have always supported individual rights to control their reproductive decisions: the right to choose whether to reproduce and create offspring. Once that biological reproduction has already occurred because conception has occurred, however, I do not think that the issue of ending that life is an unfettered individual right. Constitutional rights cut both ways, and even if attached to its mother’s body, that life has rights of its own.

I will be voting no when proposal 5 comes to the floor on Thursday. Ultimately, the voters of our state will make the decision on this amendment in November.

***

Health Care

Under the Affordable Care Act, the state has limited times when the benefits covered in plans on the Health Exchange can be revised, under strict criteria. Our committee heard this week that two benefits that people have lobbied for could be added: hearing aids and fertility treatments. The Green Mountain Care Board will make the call on these changes, including how generous the benefit may be, weighed against the level of premium increases. Reminder: decisions such as these only affect the 15% of our insurance products that individuals and small employers buy on the Exchange. States are not permitted to dictate the benefits covered by large employers, Medicaid or Medicare.

On the federal level, the new “No Surprises Act” is a mandate on all private insurance and providers. These consumer protections address situations where you might receive a much higher bill even though you cannot control the fact (or even know) that you received out-of-network care. It also will require that providers give advance estimates for medical procedures, including about your payment share. This is complicated because it involves both the provider and your specific insurance plan, so it won’t come into effect until some technology improvements are in place. It’s a good example of the push and pull that effect health care costs. These are consumer protections that have been needed for a long time. However, they will add yet more paperwork (more costs) to an already burdened system.

A piece of good news affects a small number of Vermonters in a very big way: The federal administration appears to finally be moving towards a fix of the so-called “family glitch” under the ACA, with relief as soon as next plan year. This is a collision point among rules that causes certain families to face completely unaffordable employer insurance, yet still be deemed ineligible to buy from the Health Exchange and receive subsidies or tax credits.

Speaking of subsidies… the huge added relief currently in effect due to the pandemic remains available on the Health Exchange to many people who were not previously income eligible. Hundreds of Vermonters are continuing to buy their individual plans through a private insurer and are missing out on these subsidies and credits. There is no limit or “open enrollment” time for changing these plans onto the Health Exchange. If you don’t know whether you can benefit, you can easily check by filling out the form at info.healthconnect.vermont.gov/compare-plans/plan-comparison-tool

 You should check! You might save hundreds of dollars! Do I sound like one of those scam commercials? Well, this time it’s no scam.

***

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.

January 15 2022 Legislative Update

 January 15, 2022 Legislative Update

COVID, and how it should direct our House activities, led to the longest debate of the new session this past week.

To no surprise, since we are all just Vermonters, the extreme range of public opinion exists among legislators: from those who believe that worries are overstated and based on irrational fear to those who believe that responses are inadequate and based on wrong-minded recklessness.

Among the passionate views, we managed to have a civil debate. We aren’t always perfect in that regard, but one thing I have always been proud of is our ability do to that in the Vermont state house.

This week in my committee, we needed to take time aside for a “family meeting.” There were strong feelings in a discussion over a COVID issue that ended in damaged relationships. After waiting a day, we were able to talk it through and restore trust in one another.

These relationships are critical to the give-and-take that optimizes the legislative process of listening to one another and gaining from listening. Even though a Democratic majority will always prevail on the floor, differing views create better balance when people can talk through issues in more direct and personal ways in a committee – or in a hallway.

That is one of the foundational reasons we need to get off Zoom and back in person.

As a member of the 7-person Rules Committee, which includes bi-partisan leadership members plus two at-large members, I was in the center of the debate over how and when we return safely.

A week before the session opened, we changed course from an intended full return to a two-week delay, based on the looming Omicron surge.

The concern at that point was mostly based on perceptions of the degree of future threat. We did not yet know whether a surge in cases would also result in a surge in severe illness, given our state’s high vaccination rates.

We agreed to get expert testimony to have a more accurate basis for a future decision.

In the interim, the question itself changed. While our case count has skyrocketed, our hospitalizations have not. The epidemiologist who testified told us that the precautions we have put in place means the state house is a safe place to return.

However, the case surge has vastly expanded the level of necessary, precautionary quarantines across the state. If we return in person but dozens of legislators cannot participate, their constituents lose their voices in the state house.

Thus, the Rules Committee unanimously recommended that we return in person but allow a special exemption for those who cannot not come to the state house for COVD-related circumstances to participate and vote remotely.

What a “COVID circumstance” is, we decided, should be the personal judgement and responsibility of the individual.

However, there was one glitch. Our committee rooms can operate in this kind of hybrid fashion, but the House floor needs a few added IT tweaks to achieve that full ability in the way we would want.

The Rules Committee resolution therefore called for a two-week further remote session for the full House in order to make those adjustments, but an immediate return to in person committee work with the inclusion of the exemptions.

I was the reporter of the resolution on the virtual House floor, so I took the brunt of the inquiries and challenges to this plan over the course of several hours.

Those who opposed any immediate return offered an amendment that would continue 100% remote proceedings. After robust debate, that was rejected on a 30-112 vote.

The final vote on the hybrid return was by voice, so no count was available, but it was far from unanimous. The “no” votes reflected members who wanted a full in person return, but the “yes” votes were a clear majority.

As another member of the Rules Committee said, the committee had come to a place that we felt was the right balance and in the best interest of members and Vermonters. It reached for common sense that was based upon the facts and evidence before us.

Though not everyone agreed, we had a civil debate and achieved the compromise that gets us, at least, through the next two weeks.

***

COVID work has dominated my own Health Care Committee work as well. Public health issues such as mask mandates are not before us, because they are the jurisdiction of the Human Services Committee, which is taking testimony on those questions.

Our committee is reviewing the series of emergency authorities for flexibility under the law that we gave to multiple health system oversight bodies in the spring of 2020, under extraordinary legislation that was turned around in just a few days in the last week before everyone went home.

Last year, with the pandemic dragging on, we extended most of those for a year and they are set to expire at the end of March. The timing was deliberate so that we could reassess in these first several weeks of 2022. Now, we will likely be extending most of them again.

As the time drags on, however, some of the balance between ensuring health access and protection of patients shifts.

The expansion of telehealth has been extraordinary and vital. It has taught us new ways to move into a future that includes severe shortages of health professionals.

In our emergency actions in 2020, we waived the licensing requirements for out-of-state providers to offer telehealth, and although they are required to be licensed in their home state, there is no verification system.

During the pandemic, access was the most critical part of the balance. We don’t want to cut that expanded access off now; we’ve heard from many people, particularly in the realm of mental health support, how valuable it is.

But as the dust settles, we are seeing TV ads for out-of-state companies offering services and our oversight bodies – designed to protect patients from abuses – don’t even know who they are.

So with balance as a watchword, we are working on legislation that protects ongoing access to telehealth but moves to required registration and certification of providers.

In this new arena, we had also directed insurers to reimburse for telehealth services.

It was dispiriting to find out in testimony this week that Blue Cross/ Blue Shield has violated the spirit of the emergency access provisions for reimbursement. Last fall, it cut off payment for mental health telehealth providers who were not part of its provider network.

Typically, insurers require higher co-pays for out-of-network services, but in this case, patients are being cut off completely from access to critical support in the midst of a surge in mental health need and a severe shortage of providers. We intend to be asking BCBS to explain itself.

***

The other major action this past week was the next step in the 10-year reapportionment process to adjust district lines to reflect population changes. The bill being passed in the House will put forth two different proposals to generate as much town feedback as possible before a final decision is made.

The majority position of the advisory Legislative Apportionment Board was a recommendation that all districts be sized to have one representative apiece. It creates greater equivalency among districts, but it also chops more towns into different districts.

Northfield and Berlin would be significantly affected if the decision goes one way or the other. Northfield is too large to be represented by one person, and Berlin is too small.

The LAB majority map would divide one third of Northfield to attach to Berlin for one district, and leave the other two thirds as the second, one-seat district.

The minority map (in the 4-3 vote) would leave Northfield and Berlin as a combined 2-seat district.

Under the bill, towns will have until mid-February to provide input to the legislature’s Government Operations Committee. It’s all a rush schedule because the new federal census numbers were very delayed by COVID.

Northfield’s Board of Civil Authority weighed in to the LAB in November supporting keeping our current 2-seat district. Berlin’s BCA did not submit a position.

If you have thoughts, you can contact your town BCA, me or Rep. Ken Gosland, or the House Government Operations Committee itself.

***

One last note: this early period of bill introductions often leads to news media headlines saying that “the House is considering mandating water temperature standards for pet goldfish.” Yes, that is a joke as an example. The point is that any legislator can introduce any idea and it does not mean the legislature will ever even consider it. Maintain some skepticism and reach out to me or Ken if you have a question!

***

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. Please note that you can receive this update regularly on a blind email list by request to me.

Conscience Protection and Reproductive Liberty

 

The importance of conscience protection for health care workers, most often in the context of permitting hospital staff to request to be excused from participation in abortions, has broad public support and is endorsed by the Vermont Medical Society.

Yet few have addressed the current risks of erosion of those rights of conscience in Vermont if Proposal 5, the “reproductive liberty amendment,” were to become a part of our state’s constitution.

There should be deep concern about the impact that Proposal 5 could have on our state’s hospitals, health care delivery and workforce crisis through overturning such protections.

There are inaccurate perceptions about the scope and intent of this constitutional amendment, as reflected in a November article in VT Digger which described its purpose as to “protect the abortion rights spelled out in the U.S. Supreme Court’s 1973 Roe v. Wade decision.”

In fact, the unusual wording of the constitutional amendment would do three key things: it would protect any abortion for any reason until the moment of birth (unlike the balance of state interests created in Roe for third trimester pregnancies), likely rendering null any individual hospital’s abortion policies including Conflict of Care policies; it would extend protection to any health care service that relates to 'personal reproductive autonomy' with no known definition of how far that concept might extend; and it would turn any debate over that high bar of what constitutes a “compelling state interest” over to the Vermont courts.

It offers no final word, but rather would be subjected to any number of future court interpretations.

I have again introduced a bill – H. 497 -- for conscience protection for health care providers this year. Vermont is one of only two states that does not provide it by law.

Given the breadth of Proposal 5, there is a significant risk that hospitals could not independently choose to assure such protection. Extant shortages in medical professionals, particularly in ob/gyn practice and in nursing, would worsen as some providers decide to leave their chosen professions. In fact, it might be deemed discriminatory to permit conscience protections – or even for any hospital to fail to perform abortions.

If the legislature fails to act on conscience protection before voting to move forward with Proposal 5 this year, it will form an explicit legislative intent in the record that could inform the court to rule that a future-passed conscience protection bill would be unconstitutional. Even if such a bill passes, it is not clear that it will withstand the breadth of the amendment, but I think it is still worth the effort.

I hope that Vermonters will actively support this legislation.

The issues buried within Proposal 5 warrant consideration of the impacts on quality health care before making decisions about the constitutional change. Conscience protections and the impact on the workforce are a prime example of unforeseen consequences.

Full consideration of the implications – and the ways in which they go far beyond the instinctive appeal that “protect Roe v. Wade” has for many people – is crucial.