Legislative Report 2/8/2018 - Vision Reflects Values

The President's State of the Union address is a tradition of our democracy that allows the head of the executive branch of the government to express his vision for America. It usually addresses a broad range of issues at a high level and is short on detail. Whether or not you agree with what is said, at least you get a pretty good idea of where the speaker is coming from. This got me thinking about my own communications, so I thought I'd try to deliver my own vision of what I try to accomplish as I serve as your Representative in Montpelier.

Let me start by saying that, as wonderful as Vermont is, we all want to help make our state a better place to live, work and play. We want Vermont to be affordable, not just for those at the top of the income bracket, but for everyone. Every family should have the opportunity to thrive, to be able to earn a living wage. While our minimum wage is above average, I believe that it should continue to rise gradually over time until it becomes a livable wage. Likewise, no employee should have to worry about losing their pay or even their job if they have to take time off to care for a sick child or elderly parent. That is why I voted for paid family leave last year, a bill that is awaiting action in the Senate. For those who are stuck in low wage jobs, we need to continue to increase access to training, career and technical education so that every Vermonter has a fair shot at success.

We have a great education system, but the cost of education continues to place a heavy burden on property taxes. With the additional demands placed on our schools from addiction, mental illness, and poverty, great public schools in all our communities are more important than ever in giving all children a bright future. During this session we are proposing a system of education funding that is simpler, still progressive, still subject to local control, and that will significantly reduce property tax burdens. Nor can we forget about the need to support pre-K and post high school educational opportunities.

Another core value is healthy families in healthy communities. The cost of health insurance and housing are the biggest challenges faced by many Vermonters. While Republicans in Washington are dismantling the Affordable Care Act and cutting funding for Medicare and Medicaid we need to make health insurance more affordable and ensure that Vermonters have access to treatment without barriers for drug addiction and mental health. A key to maintaining individual health is affordable housing, We need to support affordable housing development in downtowns and in village centers that also provides access to jobs, shopping and public transportation.

Finally, we need a healthy environment. We can't put off efforts to clean our lakes and streams. We have to reduce our dependence on fossil fuels which has become a major contributor to climate change. Extreme weather events as well as adverse health effects. Lyme disease, algae blooms, heat waves, and extreme cold are the result. We can't afford to do nothing,

These are some of the values that frame my work in the legislature. I hope that my work will lead to a better Vermont for us and for our children and grandchildren.

I'll end by reminding you that I will be hosting an informational forum on the topic of Pricing Carbon Pollution at the Charlotte Senior Center on Monday. February 12, at 7:00 p.m. I hope to see you there.

As always, 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).

Legislative Report 1/31/2013 - The Vermont Health Insurance Exchange

Rising health care costs and lack of access to affordable health care for millions of Americans have been a target of health care reform efforts for decades.  The passage of the Affordable Care Act (ACA), a.k.a. “Obamacare”, and the recent Supreme Court ruling that it is indeed constitutional addressed the problem on a national level.  Vermont’s own plans for its Green Mountain Care universal health care system will not be implemented until 2017, so compliance with the ACA required Vermont to take the interim step of implementing a Healthcare Insurance Exchange by 2014. Vermont is one of several states that decided to set up its own exchange instead of leaving it up to the federal government.   In this article I will explain what the Exchange is and what the practical implications are for Vermonters.

The ACA requires that starting on January 1, 2014, all individuals must be covered by health insurance, and businesses with 50 or more full-time equivalent employees must offer health insurance coverage to their full-time employees.  Federal tax credits are available both for small businesses (less than 50 employees) and for individuals to meet these requirements. 

If a person is not covered by an employer-sponsored plan or by a government-sponsored plan like Medicare or Medicaid, he or she will have to purchase their insurance on the open market or through the Exchange.  Only insurance purchased through the Exchange is eligible for federal tax credits or subsidies.  The Exchange is a list of approved health insurance options that provide standardized health care coverage at various levels of cost.  There are four benefit levels:

• Bronze – 60% payment of covered medical expenses
• Silver – 70% payment
• Gold – 80% payment
• Platinum – 90% payment.

Annual out-of-pocket payment of expenses cannot exceed $5,950 for individual coverage and $11,900 for family coverage at all four benefit levels.  Insurance premiums will vary by insurance provider, amount of deductibles and co-pays, and benefit level.

Households with income from 133% to 400% of the federal poverty level (FPL) will be eligible for subsidized premiums.  Households with incomes less than 133% FPL will be covered by Medicaid.  The federal poverty level (FPL) varies with household size:  for an individual it is an Adjusted Gross Income (AGI) of $11,496; for a household of 2, $15,516; for a household of 4, $23,556; and so on.  133% is 1.33 times those amounts and 400% is 4 times those amounts.  So, a family of 4 with household income between $30,657 and $92,220 will be eligible for premium assistance. The premium subsidy (paid directly to the insurance provider on behalf of the buyer) will vary with income level and for 2014 will be based on the 2012 tax return that is due on April 15^th of this year.   Adjustments for changes in a household’s financial circumstances can be made on a monthly basis.

The penalty for not carrying health insurance 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.

Vermont’s implementation of the Health Insurance Exchange is called “Vermont Health Connect”. Vermonters will be able to enroll in one of several plans offered through the Exchange starting on October 1, 2013.  More detailed information on Vermont Health Connect can be found at http://hcr.vermont.gov/timeline/exchange.

Healthcare

Vermont has been a leader in providing affordable health insurance options to its citizens. From the Doctor Dynosaur program instituted during the Dean administration to the Catamount Health Insurance program that was passed 3 years ago despite Governor Douglas' opposition, we as a state have moved closer to guaranteeing that affordable health insurance is available for all.

Healthcare costs, however, continue to rise and it will be important for us to get a handle on controlling them. Universal healthcare is one way to bring the hidden costs of uninsured emergency room visits into the open. A larger insurance pool will also mean that care can be concentrated on prevention rather than addressing complications due to lack of early treatment. Pharmaceutical costs can be mitigated by working with our neighboring states to negotiate lower drug prices.

Senate Bill 88 Act, which was passed by the Vermont legislature this year and became law over the opposition of Gov. Jim Douglas, has set up a commission to study and propose three alternatives to creating a universal health care system, one of which will be a Single-Payer system.  This commission has already begun its work and is scheduled to report to the legislature in 2011.  Our own options will have to take into consideration the federal legislation that was recently enacted.

After months of debate, compromise, misrepresentation, theatrics, and solid Republican obstructionism, it is not surprising that the resulting Healthcare reform legislation passed by the U.S. Congress and signed into law by President Obama still has many critics. Voices on the right object to any kind of legislation at all while voices on the left object because it doesn't go far enough to provide an alternative to private health insurance and because it still leaves about 15 million Americans without health insurance. 

Vermonters can be proud that our entire Congressional delegation, Senators Patrick Leahy and Bernie Sanders and Representative Peter Welch, voted for the final version of the Affordable Health Care for America: Reconciliation Bill. This new law is a big step forward in the campaign to provide affordable healthcare to every American. If Europe, Latin America and Asia can do it, so can we.

I am looking forward to the report from the Vermont commission on health care reform and feel confident that the Single-payer system will be seen as a viable option.  If it is, I will support it.