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Note: Blog posts entitled "Legislative Report" have been published in The Charlotte News, and those entitled "The Word in the House" have been published in The Citizen.



The Word in the House 3/18/2015 - Health Care after Single-Payer

Since Governor Shumlin abandoned plans for establishing a universal health care system, popularly known as a single-payer system, the House Health Care Committee has been trying to improve the system we currently have. Vermont Health Connect continues to have operational issues with regard to processing change of circumstance filings, and the Committee is continuing to require updates from the Administration. The Committee's main focus, however, is to address the affordability of health insurance for all Vermonters through H.481, which was voted out of committee and will be acted on by the full House.

H.481 addresses the Medicaid cost shift, provides additional assistance to under-insured Vermonters, allocates additional resources to support primary care providers and the Blueprint for Health, and increases funding and responsibilities of the Green Mountain Care Board. The bill also provides funding to pay for these reforms and policy changes. Here are the details.
 
Addressing the Medicaid cost shift: This bill provides funding, to be matched with $1.10 of federal funding for every state dollar, to reduce the Medicaid cost shift. By increasing reimbursement rates to health care providers serving Medicaid patients, it reduces the cost pressure on the 54% of Vermonters who purchase their health insurance privately. It also enhances access to the health care system for Medicaid patients.
 
Helping the under-insured: While the Affordable Care Act has reduced Vermont's uninsured rate from 7.6% in 2009 to 3.7% in 2014, the second lowest in the nation, many of the newly insured have plans that are unaffordable – high deductibles, co-pays, and out-of-pocket maximums. H.481 increases the cost-sharing subsidies for Vermonters at 200%-300% of the federal poverty level (family of 4 with income between $48,500 and $72,750) reducing deductibles from over $3,000 to $1,200 and cutting the out-of-pocket maximums from over $6,000 to $2,500.
 
Strengthening primary care: Primary care providers are the most cost-effective health care resource, and H.481 targets them for increased resources in Vermont’s health care system. H.481 takes advantage of 10:1 federal match dollars in funding Health Homes, provides educational loan forgiveness to encourage primary care providers to practice in Vermont, and funds a study on providing state-funded universal primary care in Vermont.
 
Strengthening the Blueprint for Health (B4H): B4H organizes health care resources at the community level to coordinate services for patients. The focus is on primary care and preventative medicine, moving Vermont from reactive to proactive health care. Since 2006 it has been proven to save money and improve outcomes. H.481 increases B4H state funding by $2M in FY’16 supplemented by $1.22 in federal match for every Vermont dollar.
 
Strengthening the work of the Green Mountain Care Board: The GMCB has been effective at managing costs in Vermont’s hospital system. Funding in H.481 allows the GMCB to establish rate setting protocols that address the Medicaid cost shift and the pursuit of the All-Payer rate which will allow us to establish a payment system whereby providers are paid to support improved outcomes instead of quantity of care.
 
H.481 also includes three tax proposals. First, it repeals the Employer Assessment that was used to pay for the Catamount Health system. While Catamount Health no longer exists, this assessment continues to be paid into the Health Care Resources Fund by employers that do not provide health insurance to their employees. Repeal will save these businesses $4.4M in FY’16. Secondly, it establishes a 0.3% Payroll Tax, a reduction from the governor’s original 0.7% proposal, which would be levied on all employers. It is expected to raise $17.8M in FY’16. Finally, it assesses a 2 cent/ounce excise tax on sugar-sweetened beverages. The Health Care Committee has heard extensive testimony from the medical community who believe that a major contributing factor to the increased prevalence of obesity and type-2 diabetes is the increased consumption of sugar-sweetened beverages. This tax is anticipated to raise $30.9M in FY’17 revenue.
 
In a separate companion bill that received unanimous support, the Health Care Committee adopted a provision authorizing direct enrollment with insurance carriers for individuals within VT Health Connect effective November 1, 2016, the beginning of the next open enrollment period. This is intended for individuals not receiving subsidies who wish to work directly with their health insurance company.
 
I continue to welcome your feedback on this and other issues. I can be reached by phone (802-233-5238) or by email (myantachka.dfa@gmail.com).

Legislative Report 3/12/2015 - Doyle Poll Results

The 50th annual Doyle Poll attracted 179 respondents on Town Meeting day this year. I am grateful to those who took the time to fill out the survey this year. To Senator Doyle's selection of 15 questions I added a 16th on an issue that I wanted to know your opinions about. Since it was printed on the back of the survey, however, only 140 people responded to it. Here for your consideration is a tally of the responses.



Q#

Question

Yes

No
Not Sure
1
Do you believe water quality is a major issue in Vermont?
80%
14%
6%
2
Should Vermont legalize marijuana?
42%
45%
13%
3
Should Vermont have a payroll tax to reduce the cost of Medicaid?
23%
51%
26%
4
Would a carbon tax benefit Vermont's environment?
44%
34%
22%
5
Should sugary drinks be taxed in order to reduce obesity?
53%
39%
8%
6
Should Vermont have a one-day sales tax holiday?
61%
24%
15%
7
Are you concerned about the increased use of opiates in Vermont?
91%
7%
2%
8
Is Lake Champlain as clear as you would like it to be?
6%
82%
12%
9
Should natural gas be an important part of Vermont's economy?
44%
37%
19%
10
Do you believe Vermont's health care is better than 5 years ago?
33%
35%
32%
11
Are statewide cell service and broadband important to the future of Vermont’s economy?
84%
8%
7%
12
Does Vermont have too many school districts?
60%
20%
20%
13
Should Vermont's Presidential Primary be on the same date as New Hampshire's?
30%
41%
28%
14
Do you believe that our state is doing a good job at attracting jobs to Vermont?
17%
60%
23%
15
Do you believe Governor Shumlin is doing a good job?
26%
51%
22%
16
Do you support requiring background checks for sales of guns between private parties and at gun shows?
76%
18%
6%

There were two questions that appeared in last year's survey (2. marijuana and 9. natural gas) and four that appeared two years ago (5. sugary drinks, 9. natural gas, 11. cell & broadband, and 15. Shumlin). The opinion on marijuana legalization shifted from positive to slightly negative, but otherwise opinion is evenly divided. The opinion on taxing sugar-sweetened beverages remained unchanged from two years ago with 53% in favor. While opinions of the importance of natural gas has diminished somewhat from the previous surveys, it is still seen as important. Overwhelmingly, respondents continue to consider cell service and broadband internet to be essential to Vermont's economic growth. The big switch is in Governor Shumlin's numbers. He went from a 48% approval vs. 30% disapproval in 2013 to a 26% approval and 51% disapproval this year.

Interestingly, Shumlin's Doyle Poll numbers in Charlotte were slightly worse than those of an independent VTDigger-Castleton Polling Institute survey released this week where 47% disapproved of the job he's doing compared to 41% approving. The Charlotte Doyle Poll results for other questions also lined up with those from the VTDigger-Castleton survey within a few percentage points, including support for taxing sugar-sweetened beverages, taxing carbon, and requiring background checks on private sales of firearms. (The VTDigger polling results can be found at http://vtdigger.org/majorprojects/complete-vtdiggercastleton-polling-institute-results/.)

Charlotters also support a sales-tax holiday and reducing the number of school districts and oppose a payroll tax to address the cost-shift in insurace premiums. There remains a lot of concern about opiate addiction and a strong recognition of the problem we face with pollution in Lake Champlain and state waters.

As your representative in Montpelier, I appreciate your input on these and other issues. Your comments help me look at issues from several perspectives, and that is a valuable opportunity for me. You can always contact me by phone at 802-233-5238 or email me at myantachka.dfa@gmail.com.

Legislative Report 2/25/2015 - Background Checks

Whenever legislation regulating firearms is proposed, no matter how sensible, it never fails to elicit a strong negative reaction from gun rights groups. A couple of weeks ago, the Vermont Senate Judiciary Committee held a hearing on S.31, the bill relating to possession and transfer of firearms. The hearing was packed by both supporters and opponents, each distinguished by the colors they wore: green for supporters and hunter orange for opponents. It was clear that opponents outnumbered supporters by a large margin. Witnesses were called pretty much in alternating order of pro and con, and more than 30 people testified.

The objections to the legislation fell into 3 categories: 1) a misunderstanding of what is in the bill, 2) the contention that it violates the 2nd Amendment, and 3) that the background check provision would be unenforceable. So, here is what the bill does and does not do.

There are three provisions. The first makes it a crime in Vermont for a person convicted of a violent crime to possess a firearm. This is currently federal law. However, without this provision, the crime would have to be prosecuted in federal court by a federal prosecutor. This provision would allow prosecution by a States Attorney in the Vermont court system.

The second provision requires reporting to the National Instant Criminal Background Check System (NICS) persons who are judged in a court of law to be a danger to themselves or others, or who were found not responsible for a crime by reason of insanity or incompetent to stand trial due to a mental illness and are a danger to themselves or others.

The third provision requires a background check to be conducted on a buyer of a firearm before it could be sold to that person. There is an exemption if the firearm is transferred or sold to a family member or a law enforcement agency, or to an police officer or a member of the Armed Forces acting within the course of their official duties. It does not prohibit loaning a firearm to a friend for an afternoon of shooting or hunting as some opponents claimed. This is the most controversial provision, although most opponents see every part of the bill as an infringement on their constitutional rights. On the contrary, courts have upheld the constitutionality of background checks passed by 16 other states. Moreover, background checks are required when a gun is purchased through any federally licensed firearms dealer like a sporting goods store or gun shop. This bill merely extends the requirement to online and person-to-person sales and also closes the so-called "gun show loophole", where a private seller would not require a background check while a licensed dealer in the next booth would.

We all know of the increased prevalence of heroin trafficking. Studies have shown that guns obtained in Vermont are part of the currency of the drug trade coming from New York, Boston, Albany and other places with strong gun laws. According to the Bureau of Alcohol, Tobacco and Firearms, in 2013 alone 165 guns recovered in crimes in other states were traced back to Vermont. This may not seem like a lot, but it is significant considering the size of our population.

I do not object to guns or to the traditions of hunting and sport shooting. However, as a gun owner myself I support this legislation because it is necessary to help prevent firearms from getting into the hands of criminals and dangerously mentally ill persons. I have talked to many other gun owners who support this legislation as well because it makes common sense. As the NRA is fond of saying, "Guns don't kill people; people do." So, we have to take whatever steps we can to keep guns out of the hands of the wrong people. Persons who can pass a background check when purchasing a gun from a dealer have nothing to fear from this legislation. As for enforceability, while there will always be an opportunity for a prohibited person to skirt the law by buying from an unscrupulous individual, responsible, law abiding gun owners will be helping to protect their fellow citizens when selling their unwanted guns with a background check as required by law.

I am a cosponsor of H.250, a companion bill to S.31 in the House.

I continue to welcome your thoughts and questions and can be reached by phone (802-233-5238) or by email (myantachka.dfa@gmail.com).