2004 Legislative Report

For the week ending January 28, 2005

Political Overview

This week the House Republicans selected their new leader for the next two years, Rep. Peg Flory from Pittsford. Rep. Flory replaces Rep. Rick Hube of Londonderry who announced last week that he was stepping down for health reasons. Flory will be assisted by Rep. David Sunderland of Rutland Town.

Tension is building and partisanship is beginning to take hold. The House Republicans held a press conference on Thursday morning to unveil the Governor’s health plan. Republicans believe that H. 102, An Act Relating to the Prescription for a Healthy Vermont, would reduce the number of uninsured by 20% while reducing premiums by an average of 50%. Flory warned that Vermont was headed down the same road as the Tennessee, where the Governor will have to cut 323,000 thousand adults from the expanded Medicaid system by January 2006 while capping benefits for others. The Republicans asked that the Democrats hurry with the Senate’s importation bill in order to take up reform bills that will make a difference this year, especially reform efforts that will address the Medicaid crisis. The Democrats responded by stating that the issue is so complex and the crisis so acute that it may take more than one legislative session to deal with this. Tracy stated that "we are not going to let a deadline thrown out for political purposes drive us."

A question was raised from the media on the Governor’s Global Commitment concept and if saving Medicaid was contingent on receiving approval from the Federal government. Republicans responded by stating that the Global Commitment was just one piece of the puzzle and that if we don’t receive the global commitment we should continue on with the other aspects of the Governor’s plan for reform.

The full text of H. 102, the Governor's health proposal can be found at: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/intro/H-102.HTM

Other controversial issues this week include raising the minimum wage and lowering the drinking age. Senate Democrats are intent on making raises in the minimum wage automatic and a Senate committee gave initial approval Wednesday toward that goal, although advocates do not feel that it goes far enough. Currently the minimum is $7.00 an hour and under the bill would rise again on January 1, 2006 by the same rate as inflation.

Rep. Richard Marron, R-Stowe, will be sponsoring a bill that would lower the drinking age from 21 to 18. If this proposal is passed, the State is slated to lose $9.7 million in Federal funds from the transportation budget. Opponents argue in addition to losing federal funds, there will be an increase in deaths and substance abuse problems. Many legislators are already grumbling about the restructuring of the Agency of Transportation, the elimination of 40 jobs and the consolidation proposal for redrawing the boundaries for highway maintenance districts. The prospect of losing federal funds makes this proposal almost dead on arrival.

VAHHS Issues

House Health Care and House Human Services
Both committees had the opportunity to hear from Dr. Melinda Estes, President and CEO of Fletcher Allen Health Care. Dr. Estes gave the committees an overview of Fletcher Allen including its dual role as a community hospital, a regional referral center for Vermont and northern New York, and services offered by Fletcher Allen. Dr. Estes also highlighted the economic impact Fletcher Allen offers as well as their relationship with the University of Vermont College of Medicine and University of Vermont College of Nursing and Health Sciences. Dr. Estes highlighted many achievements including: their focus on quality, nurse recruitment and retention efforts, financial turnaround in 2004, establishment of a discount policy for the uninsured, the increase in charity care to 300% of the federal poverty level, their commitment to openness and transparency, work on the new inpatient psychiatric units and their role as a resource to other Vermont and New York hospitals.

Dr. Estes also highlighted many of the external challenges faced by all Vermont hospitals. Although advances in medical technologies and pharmaceutical therapies are welcome, they don’t come without a cost. Our aging population and increased utilization also add to the rising cost of healthcare. Other rising costs include: workforce shortages, supplies, and benefit costs. In addition to these rising costs, the Medicaid crisis will add pressure to every Vermont institution. Hospitals need to identify areas for cost reduction, while preserving their mission to serve their communities. Dr. Estes stated that the State could help in our efforts to reduce costs by streamlining and easing some of our regulatory burdens related to the CON process.

The Human Services Committee heard from Secretary Charlie Smith on the “The Douglas Administration’s Plan for Saving the Vermont Medicaid System.” Sec. Smith told the Human Services Committee that they are not able to discuss the details of the negotiations with the federal government because it may put it at risk. Secretary Smith did state that the Administration and legislature need to work hand in hand through this process even though the legislature can not be directly involved in the negotiations and that a decision would not be made without legislative approval.

Human Services also did a run through of H. 58, An Act Relating to Education Loan Forgiveness for Nursing Faculty. The committee heard from Mary Val Palumbo from the Office of Nursing Workforce, Research, Planning and Development and the directors of the schools of nursing on current statistics for Vermont. The committee is supportive of this bill.

Next week the House Health Care Committee will be doing background briefings in order to get an understanding of past efforts on health reform. The House Human Services Committee will be focusing on mental health and end of life care issues. Chair Ann Pugh has asked that committee members get back to her on specific bills they would like to take up.

Drug Importation
The Senate gave final approval Thursday to the drug importation bill. This bill will allow the Governor to sign Vermont up for a program that offers consumers access to cheaper prescription drugs from Canada and Europe. The House Democrats are expected to act quickly on the bill. Below is the link to the Senate Journal with the language as passed the Senate. The bill number is S. 49. http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/journal/sj050127.htm

Senate Health & Welfare
The Senate Health &Welfare committee heard from Health Commissioner Paul Jarris and Deputy Commissioner Barbara Cimaglio. Both gave an overview of the number of individuals currently being treated for substance abuse and the number of individuals that are on waiting lists to be served. Commissioner Jarris also informed the committee that the mobile methadone clinic is slated to be online by June 1, 2005.

Commissioner Jarris took the opportunity to give a quick introduction to H. 45, a bill that proposes to establish a prescription drug monitoring program. Commissioner Jarris believes that passage of this bill is essential in order to have a system in place that can detect and prevent substance abuse.

Bills of interest introduced this week:

H. 85 - AN ACT RELATING TO NONPROFIT LEVEL-THREE RESIDENTIAL CARE HOMES AND ASSISTED LIVING FACILITIES PROPERTY TAX EXEMPTION: This bill proposes to create a property tax exemption for nonprofit level-three residential care homes and assisted living facilities.

H. 91 - AN ACT TO PROHIBIT SMOKING IN PUBLIC PLACES: This bill proposes to prohibit smoking of tobacco products in public areas, including bars with a cabaret liquor license.

H. 98 - AN ACT RELATING TO HEALTH INSURANCE PLAN REIMBURSEMENT FOR COVERED SERVICES PROVIDED BY NATUROPATHIC PHYSICIANS: This bill would allow naturopathic physicians providing treatment within their scope of practice to be reimbursed for providing medically necessary health care services that are covered by a health insurance plan.

H. 102 - AN ACT RELATING TO THE PRESCRIPTION FOR A HEALTHY VERMONT: This bill proposes to: (1) offer premium and deductible assistance to uninsured low and moderate income Vermonters; (2) create a reinsurance program to lower nongroup health insurance premiums; (3) establish a health insurance tax credit to enable small businesses to offer health insurance to their employees; (4) permit health insurance companies to offer discounts to members and subscribers who make healthy choices; and (5) establish a consumer health care price and quality information system to empower individuals to make economically sound and medically appropriate decisions.

H. 108 - AN ACT RELATING TO CIVIL COMMITMENT OF SEXUALLY VIOLENT PREDATORS: This bill proposes to repeal the existing procedures for designating a person a sexually violent predator and replace them with a procedure whereby the state may civilly commit a sexually violent predator to state custody for the purpose of involuntary mental health treatment after his or her release from prison.

H. 109 - AN ACT RELATING TO REAUTHORIZATION OF THE HUMAN RESOURCES INVESTMENT COUNCIL: This bill proposes to reauthorize the human resources investment council which sunset under Act No. 138 of 1998.

H. 115 - AN ACT RELATING TO ADVANCE DIRECTIVES FOR HEALTH CARE: This bill proposes to improve medical care for Vermonters by simplifying the legal requirements for advance directives.

S. 47 - AN ACT RELATING TO THE CREATION OF THE LEGISLATIVE HOMELAND SECURITY COMMITTEE: This bill proposes to create the legislative homeland security committee which shall study and review homeland security issues, including funding availability and coordination of effort to establish additional trauma centers around the state and coordination between the state’s national guard, local and state law enforcement agencies, and state agencies; and to make recommendations to the general assembly to assure the state’s readiness in case of terrorist attacks.

S. 49 - AN ACT RELATING TO THE I-SaveRx PRESCRIPTION DRUG PROGRAM: This bill proposes to require the secretary of administration to join the I-SaveRx prescription drug program launched in Illinois so that all Vermont residents can purchase lower cost prescription drugs from Europe and Canada. (NOTE: The full Senate has passed this bill. Work began on this bill prior to the bill having a number.)

Other items of importance

Joint Public Hearing on Fiscal Year 2006 Budget on Vermont Interactive Television - Appropriations Committees: Monday, February 14, 2005, 5:00 to 7:00 p.m. - The House and Senate Appropriations Committees will hold a joint public hearing on Vermont Interactive Television (V.I.T.) to give Vermonters throughout the state an opportunity to express their views about the State’s budget for fiscal year 2006. All VIT sites will be available for the hearing: Bennington, Brattleboro, Canaan, Castleton, Colchester, Johnson, Lyndonville, Middlebury, Newport, Randolph Center, Rutland, Springfield, St. Albans, Waterbury and White River Junction. VIT’s web site has an up-to-date location listing, including driving directions and telephone numbers: www:vitlink.org

For further information about the format of this event, call the House Appropriations Committee office at 802/828-2251. Requests for interpreters should be made to the office no later than 4:00 p.m. on Friday, February 4.

Joshua Slen, Commissioner of the Office of Vermont Health Access, is currently scheduled in front of House Appropriations for the entire day on Friday, February 18, 2005, to discuss the FY 2006 Medicaid budget.

To Contact a Legislator you may phone the Sergeant of Arms office at: 802-828-2228. To send an email: first letter of their first name, last name, .leg.state.vt.us. Example: g.symington@leg.state.vt.us.

If you have any questions related to the Legislative Report or activities on the hill you may direct them to: Lucie Garand at Lucie@vahhs.org or Bea Grause at Bea@vahhs.org.