The Word in the House 2/2/2017 - Keeping an Eye on IT

Legislation dealing with money, whether it is raising it or spending it, is often contentious and always a challenge. When the state raises money through taxes and fees, we as taxpayers want to see that it is well spent. It should be used to promote the common good, be used efficiently, and accomplish the purpose for which it is being used. This requires oversight by the legislature as well as the administration. The legislature several years ago adopted Results Based Accountability (RBA) which requires agencies to report on the results of the programs and services they provide, including how much was done, how well it was done, and whether anyone is better off. One area that has received limited oversight, however, has been the various computer systems and projects which have had mixed success with implementation. Both the legislature and the Scott administration have taken steps to address this area of concern.

One of the first orders of business for newly elected Speaker Mitzi Johnson was to establish the House Energy and Technology Committee which would have as one area of responsibility the oversight of Vermont’s Information Technology (IT) infrastructure. At nearly the same time, Governor Scott issued an executive order to change the model of the Department of Information and Innovation (DII), which had nominal responsibility for IT, and create a new Agency of Digital Services.

Up to now the administration of the various IT systems has had two parallel structures responsible for purchasing, development and management. Some of this authority is centralized under DII and some rests with the agencies the systems support. In addition, about 30% of the systems are administered independently under control of the statewide elected officials like the Secretary of State or the Treasurer. As a result, there may be duplication of effort, poor project management, and reliance on outdated legacy systems which are costly to support. In the meantime, the legislature has had little insight to the operation of the IT projects and systems but must appropriate money to fund them.

In order to improve the coordination, procurement and governance of technology and IT resources and spending, and more efficiently deliver services to the public, the executive order would have all IT projects report directly to the Agency of Digital Services while project managers and developers remain embedded in and report dotted-line to the agencies they serve.

The history of state IT projects has had mixed results, with the problems of Vermont Health Connect illustrative of the public perception of dollars not well spent. A joint hearing was conducted by the Energy & Technology, Institutions, and Health Care Committees to hear a report from an independent auditor on the current status of Vermont Health Connect. The recommendation of the audit report was that problems remain with automation of some functions involving communications with billing and insurance providers. However, they determined that the best solution is to continue work on improving VHC after analyzing a half dozen other alternatives including moving to the federal system. On top of their findings they noted that the uncertain fate of the federal Affordable Care Act under the Trump administration injects an unknown factor into the equation for Vermont’s health care system. It will be up to the legislature working with the Governor to successfully navigate through this uncharted territory.

As always, I invite you to let me know your concerns and opinions. I can be reached by phone (802-233-5238) or by email (myantachka.dfa@gmail.com).

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).

2013 Legislative Town Meeting Report - 3/5/2013

Since the 2013 session of the Vermont Legislature began on January 9^th, all committees have been busy working on legislation that will keep Vermont moving forward despite the turmoil in Washington and the continuing challenge of a slow economic recovery.  We are responding to this challenge keeping in mind not only the burdens of taxation but also the financial struggles facing hard working families, the threats to our environment posed by climate change, and the desire to ensure that Vermont is a great place to live and to do business.  Here are some of the results of our work so far.

 

The Budget

The House passed the Budget Adjustment bill in January to address a shortfall of $25M based on actual versus projected revenues and expenditures since July.  Most of the changes are in response to the reduced revenues and increased spending resulting from the slow recovery from the recession.  For the past month, the Appropriations Committee has been working on the FY14 budget. Fiscal pressures continue to be felt in every committee as the legislature tries to maintain programs vital to Vermont’s people, environment and economy.  This work is expected to extend to near the end of the session in May.

 

Health Care

The Affordable Care Act of 2010, also known as Obamacare, requires all individuals to be covered by health insurance starting January 1, 2014.  Each state is required to established a “health care exchange” that will help individuals and families purchase insurance with federal subsidies. Vermont’s individuals, families and small businesses will have access to a new insurance marketplace called Vermont Health Connect starting in October of this year that will allow them to make apples-to-apples comparisons of their health coverage options. It will serve as the place where they can access the tax credits to help pay their health care premiums. Information packets on how Vermont Health Connect will work can be found today at my Town Meeting table and can also be found at http://healthconnect.vermont.gov/sites/hcexchange/files/Town%20Meeting%20Day%20Informational%20Packet.pdf.

In 2017 the federal government will allow states to apply for a waiver from the Affordable Care Act exchanges that would allow Vermont to create a universal health care system. Once this system is in place, Vermont could save $500 million per year compared to our current system. In order to embark on a new health system, Vermont needs to do more work to be sure our health care is affordable, offers high quality and contains growth. The Green Mountain Care Board continues to work with health care providers on quality and cost containment initiatives to make Vermont's health care delivery system the most efficient and highest quality in the nation.

 

Energy and Environment

Most Vermonters heat their homes with oil and other fossil fuels. This leaves us vulnerable to constant price increases, feeds our greenhouse gas emissions, and makes our homes less and less affordable.  House bill H.216 aims to improve the thermal efficiency of our leaky housing stock. It bolsters low-income weatherization, takes steps to keep the price of oil as low as possible for people who receive heating assistance, and streamlines services for higher-income Vermonters who can more easily finance their retrofits. As the pace of home improvement picks up, we also anticipate local job growth for contractors, auditors, and other heating professionals. 

Leftover paint is considered a household hazardous waste.  The Chittenden Solid Waste District has a paint recycling program that is very effective, but other parts of Vermont do not.  House bill H.262 will establish a paint stewardship plan for the collection, reuse, and recycling of paint in Vermont.  This bill has been developed with the cooperation of the American Coatings Association representing paint manufacturers, Vermont’s solid waste districts, and the Vermont Agency of Natural Resources.  The cost of the stewardship program will be borne by the paint manufacturers and will fund collection centers that will be conveniently located throughout the state.

Transportation

A safe and efficient transportation system is integral to our economy and quality of life.  Vermont’s roads, bridges, airways, railways, and transit systems have served this need. A perfect storm of considerable pressures are bearing down on our transportation system due to increasing costs, crumbling, aging structures, decreasing state revenue, climate change with increasingly dramatic weather events, and the uncertainty around federal assistance. The need for increased revenues comes at a time when Vermont and the nation is emerging from a deep recession.  Balancing these pressures is what Vermont leaders are weighing as we consider options for transportation funding. The impacts and consequences of a system in disrepair are vast, affecting the lives of every Vermonter.  The Legislature is exploring several options to invest in the health of a system that is integral to our prosperity and well-being.

 

Combatting Substance Abuse, Addiction, and Crime

Several committees are studying aspects of drug abuse and its consequences and looking for potential solutions. House bill H.331 is one effort to create a systemic response to the problem of opioid addiction. It will work to maximize the effectiveness and appropriate utilization of the Vermont Prescription Monitoring System (VPMS) while still protecting the privacy of individuals who appropriately use medications.

The State is beginning to implement a “Hub and Spoke” System to provide care for Vermonters with addictions. A Hub is a specialty treatment center and a Spoke is the ongoing care system comprised of physicians and other addictions professionals, including counselors. One “Hub and Spoke” System in Chittenden County is in operation and others will begin operation in the near future. There are plans for five systems in the state.

Drug abuse also fuels property crime in Vermont. Ensuring public safety in our communities is a high priority for the legislature.  Home and vehicle break-ins are occurring at a high rate, in large part fueled by opiate addiction.  The spoils of these illegal activities are easily converted to cash at many places around the state.  Some precious metal dealers who are not complying with the retention period are prompting discussion of increasing penalties as well as increasing the retention period. House bill H.202 which I have co-sponsored seeks to address this problem.

Methamphetamine use does not appear to be as large a drug problem as prescription drug abuse. However, the degree of violence in combination with the highly addictive qualities associated with meth use prompts a more detailed review of state policies.  The Judiciary Committee is considering a proposal that would require pharmacists to check a real-time database to ensure that people have not already purchased meth ingredients at another pharmacy in the state within a 30-day period.

 

Pension Forfeiture

Public employees must not betray the trust placed in them by the public.  If this trust is broken, there is a mechanism that may be used to make taxpayers “whole” and restore the public trust.

House Government Operations and House Judiciary worked on House bill H.41 defining the consequences for a public employee convicted of financially-related felonies.  In addition to a jail sentence, the public employee’s retirement benefits may be subject to forfeiture, “in whole or in part.” The House passed this bill in February and sent it to the Senate.