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.

Legislative Report 2/18/2012 - Climate Change Demands Response

This past December, after a year of hearings involving businesses, environmental groups, government agencies, and other citizens, the Vermont Department of Public Service published the Comprehensive Energy Plan.  The vision expressed in the Plan to reduce our dependence on fossil fuels by moving Vermont to 90% renewable energy by 2050 is key to setting us on the correct path to our energy future.  Not surprisingly, there is resistance to that vision.  We get questions like: Climate change is a "hoax"; why are you wasting time on it?  How much can the small state of Vermont do to affect a global problem?  Why are we supporting energy resources that are economically unfeasible instead of cheaper coal, natural gas or nuclear? 

Looking at what is happening to our global environment, it is obvious that the global climate is indeed warming.  The north polar icecap as well as glaciers from Greenland to Antarctica are shrinking more each year causing sea levels to rise such that island nations in the Pacific are already losing substantial land mass.  And the effect is a feedback loop that is accelerating the change.  Solar energy, reflected less by the disappearing ice, is being absorbed and converted to infrared, which in turn heats the atmosphere.  Methane, a powerful greenhouse gas, is being released as permafrost melts in the arctic regions and organic matter that has been frozen for thousands of years decays.  Increasing CO2 and other greenhouse gases are decreasing the ability of the earth to radiate heat back into space, and the exploding use of fossil fuels since the mid-19th century has caused them to increase exponentially. 

Some will say that this is just a natural progression of the earth's thermal cycle, and maybe it is considering that the human race is part of the planet’s ecosystem, just as the dinosaurs were hundreds of millions of years ago.  Maybe our consumption of fossil fuels is just a way of recycling all that stored solar energy.  And maybe it is a tribute to our efficiency that we have learned how to recycle it so quickly.

But it doesn't change the fact that more thermal energy is available in the atmosphere to cause more energetic and frequent storms.  It doesn't change the fact that a rise in sea levels caused by the tremendous release of water stored in the glaciers and icecaps will impact coastal areas on every continent.  And it won't change the fact that some areas will see increased rainfall and flooding while others will dry out as rising temperatures and disappearing polar ice cause changes in air and ocean circulation patterns.

Maybe we have already reached the point of no return.  I hope not.  But with that hope, I want to see our policies change to at least slow down, if not reverse, our patterns of energy use, not so much for the sake of our generation, but for our grandchildren and future generations.  That will only happen by reducing our fossil fuel consumption, by learning to use the clean energy supplied so abundantly by nature even if it means some impact to the visual landscape, and by investing in research and development of technologies that will help us move toward this goal.

I am proud of the work we are doing in the House Natural Resources and Energy Committee to support that goal of making Vermont a model for clean, job-creating, renewable energy development and working with other states as they implement similar policies.

The Word in the House - 2/11/2012 - Irene's Influence on State Mental Health System

A lot of the work that is being done at the Statehouse this year has been focused on addressing problems created by tropical storm Irene.  At the end of January, a few weeks into this session, a 10 year old problem was finally tackled as a direct result of Irene.  Irene did suddenly what the legislature has wanted to do for many years: it closed the Vermont State Hospital in Waterbury. This caused severe disruption to the State’s ability to provide services to Vermonters who need acute inpatient care for mental illness. The silver lining: it forced the legislature to act and provided a capital funding opportunity that was not available before.

Since the flood, the reorganization of the mental health system has been under discussion by several committees in the House with hearings being held throughout the state.  Caregivers, hospitals, patients and their families gave testimony.  The House finally passed H.630, entitled Reforming Vermont’s Mental Health System.

The bill strengthens Vermont’s existing mental health care system by offering a continuum of community and peer services, as well as a range of acute inpatient beds throughout the state based on the principles developed by the Mental Health Oversight Committee.  These principles include:

• meeting the needs of individuals with mental health conditions, including such individuals in the Corrections system, while reflecting excellence, best practices, and the highest standards of care;
• providing a coordinated continuum of care to ensure that individuals with mental health conditions receive care in the most integrated and least restrictive settings available, honoring individuals’ treatment choices to the extent possible;
• performing long-term planning to design programs that are responsive to changes over time in levels and types of needs, service delivery practices, and sources of funding;
• ensuring that the  mental health system will be integrated into the overall health care system, including the location of any new inpatient psychiatric facilities adjacent to, or incorporated with a medical hospital;
• distributing facilities based on demographics and geography to increase the likelihood of treatment as close to home as possible;
• ensuring that the legal rights of individuals with mental health conditions are protected; and
• ensuring that Vermont’s mental health system will be adequately funded and financially sustainable to the same degree as other health services with oversight and accountability built into all aspects of the system.

A key strategy of the bill is the development of a distributed system of care in order to provide services closer to where patients live while at the same time providing facilities that offer safe and secure environments for patients that require them.  The services that were provided at the Vermont State Hospital will be provided at acute inpatient hospitals throughout the state including a 14-bed unit within the Brattleboro Retreat and a 6-bed unit within Rutland Regional Medical Center, and also by temporarily contracting for 7 to 12 inpatient beds at Fletcher Allen Health Care, by providing acute inpatient services at another temporary location, and by building a 25-bed hospital in central Vermont.  Funding for these facilities will come mostly from insurance payments for the Waterbury Complex and from FEMA Relocation and Replacement assistance.  In addition, since the State Hospital, which had been decertified by the federal government due to repeated problems, no longer exists, $10M per year in federal funding is again available for operations.  This will help the state absorb the additional expenses of the temporary arrangements.  The bill is now in the Senate.

Legislative Report - 02/09/2012 - Vermont Recycles – But We Can Do Better

We Vermonters pride ourselves on being “green.”  It’s a great attitude to have.  However, we can do better.  We have had recycling programs since the 80’s and most of us do pretty well at it.  Recyclables are separated from trash for curbside pickups, and our solid waste districts are accepting more and diverse materials in their recycling streams.  But the fact is that, despite a goal set in 1999 to achieve a 50% recycling rate by 2005, Vermont has over the last decade reached a plateau of about 36%. This means 64% of everything we throw away as a state goes to the landfill.  This is a serious problem because we presently have only two operating lined landfills, one in Moretown and the other in Coventry; and the one in Moretown is estimated to have only about 18 months before it reaches capacity. 

So, the question is: how do we increase the recycling rate and reduce the amount of waste going to the landfills.  Landfill waste can include not only things we think of as recyclables, like paper, plastic, aluminum, glass, and cardboard, but also yard waste, food scraps and other organics, which make up about 23% of the waste stream in the Chittenden Solid Waste District (CSWD). Decomposing organic matter also generates methane, a powerful greenhouse gas.   

My Committee, Natural Resources & Energy, is working on a bill, H.485, that addresses this problem.  This bill sets a timeline for increasing the recycling rate of materials and diverting yard and organic waste from landfills.

The first step is to require mandatory recycling of materials we normally associate with recycling.  Some solid waste districts like CSWD and the Addison County SWD already encourage this through a “pay as you throw” system, which charges fees based on the amount of material going to the landfill.  ACSWD’s recycling rate is currently around 50% as a result of this policy.  The bill will require similar policies throughout the state.  CSWD’s spokesperson, Jen Holliday, estimates that such policies can help us achieve 75% to 85% recovery of materials. 

The next step is to require waste haulers to pick up leaf and yard residual waste that is separated from other types of waste and deliver it to a facility for management of such material.  This would assure that the material can be either composted or otherwise used for appropriate purposes.  Examples of this type of material include grass clippings, kraft paper, brush, and other woody materials.

The third step would be to require haulers to pick up “source separated organic material” and deliver it to composting facilities.  This material includes food scraps, food processing residue and unrecyclable paper.  This requirement would only apply to large producers of organic waste such as restaurants, hospitals, universities, grocery stores, etc.   The amount is under discussion and ranges between 50 and 100 tons per year per producer.   Composting this material would turn waste matter into valuable compost that can be used to enrich the soil.  How valuable compost is can be seen by several commercial composting operations that have been started in Vermont, including Highfields Composting in Hardwick and Green Mountain Compost, which is run by CSWD.  Other ways of diverting organic waste have also been identified, such as sending grocery products that have exceeded shelf life but are still usable to food shelf facilities. 

Vermont can and must be more efficient with reducing, reusing and recycling our unwanted material. 
http://www.cswd.net/recycling/

The Word in the House - 02/03/2012

The second session of the biennium of the Vermont Legislature got off to a bright and early start on January 3^rd.  That afternoon most committees were already conducting hearings on bills that were presented on the floor that morning.

The House Natural Resources and Energy Committee, of which I am a member, began consideration of three bills.  One of the bills, H.475, is a net-metering adjustment bill.  It identifies some technical changes to the 2011 Vermont Energy Bill (Act 47) that was passed last year.  The changes are needed to smooth out some unanticipated implementation wrinkles that surfaced since passage and to allow small solar installations of up to 10 kW in size to be permitted through a simple 10-day registration process, which is currently available for systems up to 5 kW in size.   This bill passed the House last week and has been sent to the Senate.

Another bill, H.468, is a starting point for a wide-ranging discussion on how to achieve more aggressive renewable energy goals of fighting climate change and growing a robust, green economy.  It continues Vermont’s support of renewable energy development by expanding the Sustainably Priced Energy Enterprise Development (SPEED) program and by proposing a Renewable Portfolio Standard (RPS) for Vermont.  The RPS sets a goal of having utilities obtain 80% of their electricity generation from renewable resources by 2025.  This bill is likely to evolve significantly during the committee process, with details changed or refined as we hear testimony from various stakeholders.

The third bill, H.485, pertains to solid waste management.  Given that there are only two operating lined landfills in Vermont , and that one of them will reach capacity within 18 months at today’s rates of trash disposal, it is imperative that we divert as much material from these streams as we can.  Vermont’s recycling rate has leveled off at around 32%.  We can do a lot better than that.  H.485 seeks to promote sustainable materials management, lessen Vermont’s reliance on waste disposal, and create a waste management system that promotes energy conservation, reduces greenhouse gases, and limits adverse environmental impact.  It will phase in, between now and 2017, mandatory recycling of common household materials that are now recycled on a volunteer basis, as well as leaf and yard waste, and “source separated” organic material from restaurants, schools, hospitals, etc.  The latter material is better used for composting to return the nutrients to the soil than for landfill material.

Other committees have also been hard at work.   Appropriations worked long hours for several weeks to construct the 2012 Budget Adjustment bill.  These adjustments are necessary to bring the budget into balance based on actual versus projected revenues and expenditures since July.  Most of the changes are in response to the devastation of tropical storm Irene.  21 temporary positions were added to the Agency of Transportation and 17 positions were added to Health Access because of increased caseload.  12 more positions were added to other departments.  Most of these positions will be filled by transfer of employees from other departments.

Solar Farm Siting: Why Can't the Town Decide?

 “Beauty is in the eye of the beholder.”  “One man’s junk is another man’s treasure.”

The range of responses by Charlotte residents to two solar projects that were proposed over the last several months reminds me of those aphorisms.  Some folks can’t stand the sight of solar panels while others get excited by them.  Some folks like the idea of renewable energy generation but are concerned that a large scale solar farm near their residences would detract from their property values.

While the decision for the relatively small Thompson’s Point solar project involved a high degree of public participation that got results for those opposed to it, the solar farm project proposed adjacent to Hinesburg Road is subject to an entirely different review process.  This review, which applies to large scale renewable energy projects, is called the Certificate of Public Good (CPG) process and is conducted by the Public Service Board (PSB) to determine if a permit will be granted.

A lot of people are asking, “Why does the Public Service Board have the final say?  What about our planning and zoning bylaws? Why should the state be butting in on a local decision?”  In this article, I will try to explain briefly the how and why of the process.

For small scale solar or wind generation like a homeowner might install, the permit process is pretty simple.  For commercial scale electric generation, however, the amount of electricity being pumped into the electric grid, the connections required, the effect on the environment, the utility buying the electricity, the cost of the electricity, and the effect on rates must be considered.  The PSB is charged in Vermont law to oversee and regulate everything that involves public utilities so that the public is protected and energy availability is guaranteed.  The rules by which it does this for any new project are contained in Section 248 of Title 30 of the Vermont Statutes. 

These rules set up a quasi-judicial process, which means that the PSB effectively acts as a judge to determine if the project is in the public interest and whether any adverse effects are outweighed by benefits to Vermont and the general public.  The PSB takes into consideration many criteria, including the need for the power, alternatives to meeting the demand, the economic benefits like jobs and taxes, Act 250 criteria for environmental effects, aesthetics, how it affects the stability and reliability of the grid, whether it conflicts with Vermont’s energy plan, and whether it contributes to the general good of Vermont.  It is the responsibility of the developer to demonstrate that all these criteria are satisfied.  Moreover, the PSB is very open to participation in the review process by affected individuals, local officials, and other parties as interveners, either on their own or through legal representation.  After hearing all the evidence, and with input from an able staff of technical experts and lawyers, the board may approve the project, reject it, or require modifications that have to be satisfied for approval.

Just as a judge has the authority to make a decision in a court case, the PSB has the ultimate say in a Section 248 case.  However, if any of the parties disagrees with the PSB’s decision, they can appeal the decision to the Vermont Supreme Court.

The bottom line is that the CPG process attempts to ensure that the decision is in the best interests of everyone based on the facts presented.