Legislative Report 4/3/2019 - Steps to Address Climate Change

This past week in the Vermont House saw several major bills passed with significant floor debate. They included Broadband Deployment (H.513), Childcare (H.531), Workforce Development (H.533), and the major money bills including Transportation (H.529), Revenue (H.541), and the Budget (H.542) plus a controversial Weatherization bill (H.439) that increases the Fuel Tax by 2 cents per gallon.  After many weeks of long hours and input from all the policy committees, the administration, and individual legislators, the House Appropriations Committee presented a balanced budget, which passed 139 to 1, that is 2.6% higher than last year’s but less than the 3.1% increase proposed by the Governor.  These bills, now headed to the Senate, are significant and deserve describing in more detail than this article will allow.  Instead I will focus on elements of the budget that address climate change.

Three reports that were issued last year highlighted the importance of addressing climate change during this session: the Intergovernmental Panel on Climate Change (IPCC) Special Report on global Warming, the Fourth National Climate Assessment released by the Trump administration, and the Vermont Department of Environmental Conservation Greenhouse Gas Emissions Inventory Update.  The IPCC report noted that we are already seeing the effects of a 1 degree Celsius rise in global temperature and gave a dire warning that we have to reduce global CO2 emissions 45% by 2030 to avoid a 1.5 degree increase which would have catastrophic geologic and demographic results worldwide. The Vermont DEC reported that Vermont’s greenhouse gas emissions have increased 16% over 1990 levels, mainly from transportation (43%) and heating (24%). We have a global problem which will require global action, including Vermont’s, to solve.

The House has taken a number of steps in this direction with the passage of the budget and revenue bills. The budget includes $1.5M for an electric vehicle (EV) incentive program, $300,000 for public charging stations, $500,000 for EVs and charging stations for state government, $250,000 to Efficiency Vermont for weatherization assistance for moderate income families, and $350,000 for weatherization workforce training.  While the budget passed almost unanimously, The Weatherization bill with the fuel tax increase was the most controversial.

We currently pay 2 cents per gallon on heating oil, propane, and dyed diesel fuel and 0.75% on natural gas. The revenues fund the Weatherization Assistance Program for families below 80% of median family income to reduce the amount of fuel needed to heat their homes.  Combined with federal funds, the program benefited 860 families in 2018. The need is much greater, however.  Because of the understandable prioritization to serve the lowest income families first, many eligible, low income Vermonters are waiting years to be served while thermal energy continues to be wasted, unnecessary amounts of fossil fuels are burned, and Vermonters continue to live in cold, unhealthy and dangerous conditions. By increasing the tax from 2 cents to 4 cents on liquid fuels and from 0.75% to 1% on natural gas, an additional 400 families can be assisted.

This tax increase was debated over two days with several amendments offered.  Opposition centered on the additional cost to the low-income families it’s supposed to help as well as the additional cost to farmers and loggers who use large amounts of dyed diesel. One amendment was passed to exempt farmers and loggers not only from the increase but also from the existing 2 cents per gallon. (The House earlier also approved an exemption from the sales tax for logging equipment.) This bill, which passed by voice vote, is beneficial for the following reasons:

1) The weatherization program, in existence from the 1970s, has been very successful in helping low income families reduce their heating bills, live healthier, and reduce greenhouse gas emissions.

2) The additional cost is minimal. A typical household using 750 gals of heating oil a year will have an additional cost of $15 over the entire heating season.

3) The price of fuel oil varies ten times as much during the heating season.  This year my deliveries ranged from $2.75/gallon to $3.00/gallon.  A 2 cent increase adds only $2 more on a 100 gallon delivery which today costs $290.

4) The savings are huge. Weatherization typically saves 29% of fuel use resulting in $500 to $600 savings per season and results in cumulative savings over time instead of cumulative wasted fuel and money heating a leaky house.  This is money that stays in Vermont compared to 80% of fuel dollars which leave Vermont.

5) It reduces dependence on LIHEAP and other fuel assistance which lasts only for the season.

6) It creates more construction jobs in the weatherization field.

I see this as a win for low-income families, a win for the economy, and a win for the environment!

I welcome your emails (myantachka.dfa@gmail.com), phone calls (802-233-5238), or in-person contacts.  

Addendum: While I normally don't link to other publications within articles I write, I want to link to this VTDigger column which speaks to the same topic for reasons you will find obvious.
Margolis: In the legislative arena, worthy goals can sometimes conflict

The Word in the House 4/29/2015 - Promoting Healthy Workplaces

A couple sits down in a restaurant. A waitress comes over to take their order. They notice that she is all stuffed up, and as she recites the specials she turns away to cough. Who can blame them if they are more than a bit uncomfortable when she delivers their food? A meeting at the office is punctuated by sneezing and nose-blowing by a co-worker around the table. A week later several people have called in sick or are spreading their own cold germs around the office. A mother wakes up her 9-year old one morning and discovers that he has a 101 deg-F temperature. If she calls in to work to stay home and care for her son, she'll lose $80 from her next paycheck. She's already behind in her bills and can't afford to lose that money. But she has to stay home for her child's sake. You get the picture.

There are about 60,000 working Vermonters who do not get paid time off if they or a member of their family are ill. They face a choice of losing critical wages or, in some cases, losing their job, or putting others at risk of getting sick. Last year a similar bill had been introduced but failed to gain enough support to make it out of committee. Over the summer legislators, businesses, worker representatives and advocates got together and reworked the proposal to make it more acceptable to employers while providing a modest but needed benefit to employees. As a result, this past week the Vermont House of Representatives passed the Healthy Workplaces bill, H.187, to address this situation. Passage of the bill did not come without a great deal of controversy and floor debate. When the final vote was taken, the bill passed 72 to 63.

So, what does the bill actually do? H.187 guarantees that working Vermonters will be able to accrue up to three paid sick days each year. For every 40 hours worked, employees earn one hour of earned sick time. Eligibility includes all permanent workers, whether full time or part time. These hours can be used for personal illness, the illness of a family member, or seeking protection from domestic and sexual violence. While the accrual of time begins in 2016, employees would have to wait until they have worked 1400 hours or one year - whichever comes first - before they could access this benefit. Working full time, the 1400 hours would be equivalent to eight months of work. Starting in 2018 the amount of annual paid time that employees can earn would increase to five days. Certain workers are exempt from this rule. Seasonal workers, such as gardeners, ski area temps, and students who work during the summer or vacations are not covered. Nor are persons with guest worker visas, nor proprietors, partner-owners, managers or executives of a business. If the sick days are not used, they can be carried over, but an employer does not have to pay an employee for time not taken.

Opponents have suggested that this legislation will result in drastic increases in payroll costs. However, calculations suggest a one-time 1% increase in payroll in 2016 for employers currently providing no paid time off to any employees, followed in 2018 by a one-time 0.5% increase. Employers who currently offer any type of paid leave will be minimally affected as long as this time off can be used for unscheduled illness or safety concerns for themselves or their family. For example, if an employer offers five days of vacation time, reclassifying it to five days of combined time off (CTO) will put them in compliance. A separate sick time policy is not required. The bill is a minimum standard and employers are free to offer additional paid time off as part of their existing benefit package. This bill will positively affect thousands of working Vermonters, and businesses will gain by the improved loyalty and health of their employees.

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).

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).

2014 Legislative Town Meeting Report - 3/4/2014

There are 14 committees in the House of Representatives.  Of the 869 bills that have been introduced in the House last year and this year, about 125 have been considered in committee and passed by the House and sent on to the Senate. Another 30 introduced in and passed by the Senate were sent to the House. Of these, 108 were passed by both and sent to the Governor for his signature.  Each committee is still working on many bills we hope to complete during the remainder of this session.  Here are some of the results of our work so far this year.

Energy and the Environment

Our renewable energy sector is growing at a significant rate with Vermont having the highest rate of jobs in the solar industry on a per capita basis, tripling the state’s solar jobs since 2012.  The net-metering expansion bill, H.702, that my committee, Natural Resources & Energy, worked on and which was passed by the House and sent to the Senate, will continue this growth through 2016 when the federal renewable energy tax credits expire.  The industry is now approaching a point where solar energy is becoming an affordable commodity for average homeowners.  We also have the battery recycling bill, H.695, ready to be voted on by the House when we come back from Town Meeting break.  I have written about both of these bills in more detail in my weekly articles, and they can be found on my website.  We have also worked on a pair of land use bills, H.809 and H.823, that will encourage development in designated downtowns and growth centers by streamlining the permitting process while discouraging sprawl and strip development.  H.809 has passed the House already and is now in the Senate.

The Corrections & Institutions Committee has also been looking at ways for state government to save energy and reduce greenhouse gas emissions.  The State of Vermont spent $14 million on energy in FY12, emitting millions of tons of carbon dioxide.  Over the past six years the legislature has worked to provide a strategy and the necessary tools for the State to reduce its energy consumption annually by 5%.  Past action of the Legislature has required the incorporation of energy efficiency and thermal conservation in any new state building or any renovation over $250,000 and to include renewable energy resources as appropriate.  It has required the Department of Buildings and General Services to analyze energy consumption in each property and to conduct energy audits in 20% of its properties annually so that it may understand how to strategically improve its buildings. The first group of properties was completed in 2013. This year we are moving forward to add the final tool necessary to accomplish the goals of saving money and reducing greenhouse gas emissions by creating an Energy Revolving Loan Fund of up to $8 million, using a credit facility the State Treasurer will make available.  With the creation of this fund, the State of Vermont will now be able to make a significant difference in its energy consumption, reduce its carbon footprint, and provide leadership in building management.

Health Care

The Health Care committee continues to keep close watch on the enrollment updates and the technical challenges with Vermont Health Connect. The good news in Vermont is that our insurance carriers, our navigators and our health care providers are working very closely together to be sure that Vermonters don't see a lapse in coverage because of the technical glitches. The value of this cooperation really can't be overlooked. Although there are still technical problems with the VHC web site, the insurers are working very hard to do what is right by Vermonters. As we come to the end of the open enrollment period, it is very important for Vermonters who are uninsured or were on VHAP or Catamount to get on the Vermont Health Connect website and enroll by March 15 for coverage beginning on April 1. If you have insurance now that renews later in the year, you will still be able to enroll on your enrollment anniversary. If you need help resolving an application that is in process, or if you need to enroll please contact me and I can help you get connected with an enrollment navigator.

The Lyme Disease bill, H.123, has just been voted out of committee and will be voted on by the House.  Lyme disease is on the increase in Vermont, and many Vermonters who have contracted the disease have experienced frustrating and lingering symptoms. The Health Care committee has heard extensive testimony from Vermonters whose lives have been significantly impacted by this disease. There is disagreement in the medical community about the best way to treat people whose symptoms don't clear up with the standard course of treatment, and many physicians have been reluctant to treat the symptoms beyond what is recommended by the CDC. H.123 is modeled after what New York did in 2005 to assure physicians that if they follow treatment guidelines from the International Lyme and Associated Diseases Society, the Centers for Disease Control and Prevention, or the Infectious Disease Society of America, they will not be subject to disciplinary action regarding those treatments.

Transportation

Highway safety is a long-standing priority of the Legislature. Hand held cell phone use, like drunk and drugged driving, poses a significant threat. The committee heard testimony about studies that compared the distractions associated with holding a cell phone to that of driving intoxicated.  This year, the House passed a bill, H.62, that prohibits the handheld use of portable electronic devices on Vermont highways while a vehicle is in motion. Portable electronic devices include cell phones, PDAs, MP3 players, GPS and other mobile electronics. The bill allows the use of these devices in hands-free mode. It also allows drivers to activate or deactivate a device if it is mounted in a cradle or otherwise fixed to the vehicle. There are several other exceptions to the handheld prohibition. They include: 

·         Law enforcement may use handheld devices in the course of their duties.

·         Agricultural vehicle operators may use a handheld device to receive a dispatch.

·         Anyone may make a call in an emergency to law enforcement or other emergency personnel.   

·         Commercial drivers fall under the commercial motor vehicle laws, which mirror federal regulations, including prohibition of the use of handheld mobile phones and other devices.

Penalties for violating the provisions of H.62 would be the same as texting while driving. A $100 fine and 2 points would be assessed for a first offense. H.62 is an important step toward promoting highway safety. 

Opportunities for Improving Our Education System

Last year, Vermont students ranked second in the nation on the National Assessment of Educational Progress tests. Similar test scores showed that, if Vermont was its own country, our students would rank seventh in the world in academic performance. Our commitment to education at the state and community level is strong and yields exemplary results.  Our education financing system, established under Act 60 in 1997 and refined under Act 68 in 2003, is regarded as one of the most equitable in the nation. The Education Committee heard multiple reports from national education policy expert Lawrence Picus and statewide leaders. Equity remains an important value that we should uphold when making any modifications to the system.  While we are proud of our education system, there are opportunities for bringing it into the 21st century and creating a more transparent, sustainable funding method. We have heard from constituents about the burden of escalating property taxes, losing vital programs in our schools due to funding and scale, a desire for measuring student outcomes against our spending, and maintaining local control while increasing budget transparency. The legislature has made education governance and financing a top priority for this session.  I will continue to provide information about this as it develops.

Who are they kidding? Obamacare IS good for America!

Sen. Ted Cruz and the Republicans in Congress keep saying that the majority of Americans don't want Obamacare.  In the states that are working to implement the health care exchanges themselves, people are overwhelmingly for it.  It's in the states whose governors and legislatures rejected Obamacare and let the federal government create the exchanges that support is lacking.  And why not?  If people only hear their leaders bad-mouthing it and spouting misleading and false information about it, no wonder they say they don't like it.
Would someone please tell me how it can be bad for the American people when it will help 30 million more who are uninsured or underinsured obtain health insurance at a reasonable cost?

Legislative Report 9/12/2013 - Navigating the New Vermont Health Insurance Marketplace

Vermont will embark on a new era in health care on October 1, 2013, as the health insurance marketplace, called Vermont Health Connect, opens for enrollment.  Vermont is one of several states that set up its own marketplace under the Affordable Care Act (ACA), a.k.a. “Obamacare”.   Vermont Health Connect is designed to make it easier for eligible Vermonters to have access to and choose the level of coverage and cost for their health insurance as well as provide Vermonters access to federal subsidies based on their income level.  Only insurance purchased through Vermont Health Connect is eligible for federal subsidies that can lower premiums, and for many, out-of-pocket expenses.  The Vermont Health Connect website, www.VermontHealthConnect.gov, already has detailed information available.  As implemented in Vermont, Vermont Health Connect will be used by Vermonters purchasing individual or family plans and employers and employees of small businesses.  It is easiest to address these categories separately for clarity. 

Coverage for Individuals and Families

So, who is eligible to participate?  Simply put, any Vermonter who does not have insurance through their employer or through a government program like Medicare, Medicaid, Veterans Administration benefits, or Dr. Dynasaur for children, is eligible.  Even if an employer offers health insurance, but the premiums cost more than 9.5% of the employee’s household income, the employee is eligible to purchase insurance through Vermont Health Connect and receive federal subsidies.  The open enrollment period starts on October 1, 2013, and ends on March 31, 2014.  After the open enrollment period, only “life changes”, such as marriage, loss of job, change in family size, etc., will be acceptable reasons to initiate or change insurance options.

Vermont Health Connect offers a list of approved health insurance options that provide standardized health care coverage at various levels of cost.  The standard plans have four benefit levels:

·         Bronze – 50% payment of covered medical expenses

·         Silver – 60% payment of covered medical expenses

·         Gold – 80% payment of covered medical expenses

·         Platinum – 90% payment of covered medical expenses.

Each level has different deductible and maximum out-of-pocket amounts.  Insurance premiums will vary by insurance provider, amount of deductibles and co-pays, benefit level, and amount of subsidy an individual or family is eligible for.  There are two insurance providers for Vermont, Blue Cross Blue Shield of Vermont and MVP, each of whom offers the same coverage in the standard plans.  In addition to the four standard plans, there are non-standard plans offered by BCBS and MVP as well.  Catastrophic health plans are also available to individuals under 30 years old who meet certain income eligibility standards.

Federal subsidies for the premiums are based on household income and are paid directly to the provider to offset the premiums.  While the estimated subsidy for 2014 is based on the household income shown in the 2012 tax return filed this year, the subsidy will be adjusted when the 2013 tax return is filed; so, those who have had a major change in income can potentially see a change in the amount of the subsidy they are eligible for.  Adjustments for changes in a household’s financial circumstances can be made on a monthly basis.

Besides the health insurance plans, Vermont Health Connect also provides access to dental plans through Delta Dental for both adults, as a supplemental plan, and children, as dental is embedded in all medical plans for those up to 21.  Catastrophic dental care is integrated with the health insurance plans through BCBS and MVP. 

There is help every step of the way for individuals to learn more now and to enroll after October 1^st:

• Online – www.VermontHealthConnect.gov
• Phone – 1-855-899-9600 (toll-free)
• In-person – Use our website or call center to find a Navigator near you.  (Navigators are trained partner organizations or individuals who can guide you through the process.  A list can be found under the tab “Assisters & Partners” at the website.)

Starting in 2014, there is a federal penalty for not carrying health insurance. The penalty will be assessed on tax returns starting in 2014 and increasing each year through 2016.  For 2014 the penalty is the larger of 1% of household income or $95 per individual household member without coverage up to a maximum of $285. 

Small Business Participation

Small businesses, with 50 or fewer full-time employees will offer health insurance through Vermont Health Connect starting in 2014. There is no federal penalty for small businesses that do not offer health insurance to their employees.  Businesses will select a contribution level and the plans available to their employees (either all plans under one carrier or the full range of options).  The employee would then enroll in the plan of their choice through Vermont Health Connect.  If the employer offers health insurance to its employees, however, the employee would not be eligible for a federal insurance subsidy unless the cost to the employee exceeded 9.5% of the employee’s household income. 

Employers are eligible for federal tax credits if

• they have fewer than 25 full-time-equivalent employees (FTEs),
• the average annual wage per FTE is less than $50,000, and
• they contribute at least 50% of the health insurance premium per FTE. 

While there is no federal penalty for small employers that do not offer health insurance, the Vermont Employer Assessment remains.  This Vermont penalty is $40/month/employee for the 5th through the 49th employee.  (The first 4 employees are exempt.)  Therefore, each employer should analyze the effect on both their business bottom line and their employees before making a decision on whether or not to offer health insurance. The Small Employer Estimator, available now on www.VermontHealthConnect.gov, is designed to help employers with health coverage decision-making for 2014.

 

Employers who choose to enroll must select their coverage options by October 1st; employees should then enroll by November 30th.  Additional tools and resources are available specifically for small businesses and can be accessed at www.VermontHealthConnect.gov or by calling 1-855-499-9800 (toll-free).

Legislative Report 4/18/2012 - Immunizations Revisited

One of the most controversial bills to come out of the legislature this session has been the Immunization bill, S.199.  The question it addresses is under what circumstances, if any, should a child be allowed to attend a public school or a day care facility without having received the age-appropriate vaccinations required by the Vermont Department of Health. 

On the one hand, there is the issue of protecting the public, especially children, from outbreaks of dangerous communicable illnesses as a result of low vaccination rates.  On the other, there is the concern of many parents that some vaccines present a higher risk for serious illness than the diseases they are meant to prevent.  Another aspect of the debate is whether the statistics showing an increase in the percentage of children who enter school "unvaccinated" accurately portray the situation. 

I have been following the debate on this issue very closely, paying attention to the concerns on both sides of the issue.  I have been fortunate to get input not only from constituents, medical professionals and parent advocates, but also from members of the House Health Care Committee on all aspects of the immunization debate.  They have taken testimony and discussed it in great depth.  I believe the committee came up with alternative language that recognizes the necessity of immunizations for maintaining public health as well as the concerns that some parents have regarding certain vaccines.

The vaccination rates for all the required vaccines except chicken pox are more than 90% statewide.  The chicken pox, or varicella, vaccine is at 87%.  However, while the data may show satisfactory rates of immunization for specific vaccines overall, there are pockets of the state where vaccine rates are critically low and need to be increased to keep both children and immune-compromised adults safe.  The House Health Care Committee, after consultation with school nurses as well as parents and doctors, decided to rely on education rather than a mandate and included a $40,000 appropriation for that purpose.

The committee's amendment will retain the philosophical exemption, but will require parents to consult with their pediatrician and acknowledge that they have been informed of the risks of not having their children immunized by signing a form.  Recognizing that the statistics showing decreased immunization rates do not distinguish between rejection of all vaccines and rejection of one or two, or postponement of a vaccine, the bill requires two more years for reporting of vaccination rates among school-age children.  In addition to K and 7, statistics for 1st and 8th grade will also be reported to the VT Dept of Health by each school.

It is my firm opinion that vaccines are crucial to preserving the public health and that government has a responsibility to promote their use even to the point of requiring them.  Since the main objective is to increase the overall rates of immunization, however, I support S.199 with these modifications because I believe that it addresses the immunization issue with the proper balance.

Legislative Report 3/4/2012 - Town Meeting and Vaccines

[This article appeared in the Charlotte News on March 6, 2012.]

We are now at the half-way point in the legislative schedule.  A lot has been accomplished so far, but there is still quite a bit to do before we are finished.  Town Meeting gives us a chance to get back in touch with our communities, so I hope we were able to connect there.  My legislative summary report that was available at Town Meeting can also be found online at my website, www.MikeYantachka.com.   



Rep. Mike Yantachka interviews Health Commissioner
Dr. Harry Chen on the Chittenden County Democrats
Show March 5, 2012



A major topic of interest that has generated a lot of emails is Senate bill S.199 which does away with the philosophical exemption for childhood vaccinations while retaining the religious and medical exemptions.  I have been listening to arguments on both sides of the issue.  To me it is a question of balancing the rights of parents to refuse a medical treatment for their child versus the threat to public health that such exemptions may pose.  Whichever position has more weight, it is important to know what the bill does and does not do.

1. It retains exemptions on religious and medical grounds.  Courts have treated religious objections differently than philosophical ones, and some medical conditions preclude the administration of certain vaccines.
2. It requires children entering public school to be vaccinated for certain diseases.  The particular immunizations are designated by the Vermont Department of Health appropriate to the age of the child. 
3. It establishes a pilot program that would have the goal of making vaccines available at no cost to all Vermonters and to reduce the cost at which the state may purchase vaccines.

The arguments against the bill include individual rights of parents to control what medical treatments their children receive, the possible dangers that vaccines may pose, and anecdotes of reactions to vaccinations.  It has to be acknowledged that a small minority of individuals, children included, do suffer an adverse reaction to some types of vaccines, although the type of vaccine causing the reaction varies with the child.  It is also true that vaccinations are not 100% effective; so some kids may get pertussis, for example, despite being immunized.

On the other hand, the responsibility of the public health system is to protect the public from health threats, which include infectious diseases.  There is no doubt that infectious diseases are still around and that many more people would suffer if vaccines were not available.  It is also true that if a child brings an infectious disease to school, it puts others at risk, for example, someone who is pregnant or immune compromised. 

When I was a child, polio was the scourge of the day.  I remember being taken by my mother to the local American Legion hall where vaccines were being administered to the public.  Today, polio is virtually nonexistent in the United States.  However, it still exists in other parts of the world, and a few cases in the 90’s occurred in the U.S. as a result of being carried from abroad.  The fact that some infectious diseases are so rare today is due in large part to the availability of vaccines.  That said, I’ll be listening to all points of view and learning as much as I can to inform my vote on S.199.

The Word in the House 2/24/2012 - The Next Step in Health Care Reform

Not unexpectedly, the Health Care Reform Implementation bill, H.559, generated a lot of debate on the House floor this past week, about 15 hours.  In comparison, the debate on last year’s health care bill lasted around 18 hours.  This treatment of how health care benefits are provided is very complex, but I will try to give an overview of the salient points of this bill.

The purpose of this year’s bill is to set up the health benefits exchange that was mandated by the federal Affordable Care Act (ACA) of 2010.  It begins to separate access to healthcare benefits from employment status.  The exchange will allow consumers to compare insurance products through a standardized portal and will benefit both small businesses as well as individuals by letting them choose a benefit plan that best suits their needs with greater affordability through federal tax credits and subsidies. 

The exchange will feature 4 levels of plans (bronze, silver, gold and platinum) from two instate insurers as well as a minimum of two multistate insurers.  Consumers will have a choice of at least 10 different plans to choose from.  There is also a provision to grandfather many current plans.  Premiums will be based on income of the insured person or family.  Up to $300M of federal subsidies will be available to individuals in the form of tax credits depending on how many individuals buy insurance through the exchange.  This is why it is important to broaden participation as much as possible.  The greater the pool of participants, the lower the costs will be to the plan.

Beginning in 2014 businesses with fewer than 51 employees will be required to purchase insurance through the exchange if they choose to offer health insurance to their employees.  They may also choose to help their employees purchase insurance through the exchange instead.  Individuals who do not have health insurance through their employer or who are not working will be required by the ACA to purchase health insurance, thereby guaranteeing that everyone is covered under some level of insurance plan. 

To help pay for this coverage, individuals or families up to 400% of poverty level ($92,200 for a family of 4 or $44,000 for a single person) will be eligible for the federal assistance.  For example, it is estimated that a household making less than $52,625 would pay no more than 9.5% of its income.  Insurers could also offer wellness rewards and discounts. 

One of the important features of this bill is a ban on discretionary clauses in health insurance policies.  This type of clause is found in practically all health insurance policies written in Vermont and allows the insurer to have the final say in decisions as to whether to pay a claim.  Courts have deferred to these clauses even when consumers have appealed decisions.  A vote on this provision to disallow such clauses was passed unanimously, joining 19 other states that have a similar ban.

Recognizing that even under the present system of private insurance there is no way to predict future costs and that historical premium increases have sometimes exceeded 15% per year, analysis has shown that with the subsidies provided under the Affordable Care Act, small businesses who currently provide health insurance for employees will save money and employees of those that don’t will be able to purchase affordable insurance.  Finally, health insurance through the exchange will be portable, i.e. you won’t lose it if you lose your job.  

Passing this bill puts Vermont in the position of determining its own health care future rather than having it be defined and implemented by the federal government in 2014 when all states are required to do so.

ANR Advice on Failed Septic Systems and Safe Drinking Water

Although Charlotte and Hinesburg have not been seriously impacted by flooding as a result of hurricane Irene, you may know someone who has been.  The information also applies to any failure of onsite septic systems.

The Vermont Agency of Natural Resources has issued advice and guidance to homeowners who have experienced failures of their septic systems that you can pass along.  It is imperative in such cases to protect drinking water supplies.  The ANR press release can be found at http://www.mikeyantachka.com/p/anr-offers-advice-for-homeowners-with.html. 

The press release also provides links for more information about drinking water safety and health concerns after a flood, http://healthvermont.gov/enviro/water/flood.aspx, and flood clean up and mitigation, http://www.anr.state.vt.us/site/html/flood.htm .