Category Archives: Health Care

Exchange work to continue, despite SCOTUS ruling

MONTPELIER — A U.S. Supreme Court ruling handed down Thursday ensures that some Vermonters will continue to be eligible for federal subsidies through Obamacare if the state opts to abandon Vermont Health Connect later this year.

The court upheld a major challenge to the Affordable Care Act in a 6-3 ruling Thursday, ensuring that nearly 9 million people receiving federal subsidies under the law can continue to receive them regardless of where they live. The challenge to the law contended that the subsidies were only available to states that created their own exchanges, like Vermont.

VHCThe challenge could have had major consequences in Vermont had the court ruled the other way. The state’s exchange, Vermont Health Connect, continues to face technology challenges. Some major functions that were supposed to be part of the state’s online health insurance marketplace continue to struggle.

Democratic Gov. Peter Shumlin has said the state would look to transition to the federal exchange if those functions were not working properly this fall. Vermonters will continue to receive federal subsidies in that event because of the court’s ruling Thursday.

Shumlin issued a statement Thursday after the ruling was announced saying the administration is continuing to work on Vermont Health Connect to ensure it works properly for Vermonters.

“We are making progress to deliver the services Vermonters expect through Vermont Health Connect. We have insured nearly 20,000 Vermonters who previously did not have insurance, and now Vermont has the second lowest rate of uninsured in the nation,” he said.

The state completed an upgrade to the website earlier this month to incorporate the so-called change-of-circumstance function. When fully implemented, it will allow customers to make life change to their accounts online, including marriage, death, birth of a child or a change in jobs. Another function, automated policy renewals, should be up and running this fall.

Republican Lt. Gov. Phil Scott, who has said he is considering a run for governor, used the ruling Thursday to call for Vermont to abandon its own exchange. Scott has been a critic of Vermont Health Connect’s challenges.

Lt. Gov. Phil Scott

Lt. Gov. Phil Scott

“For 18 months, officials have dismissed repeated calls to explore alternatives to our dysfunctional exchange, saying to do so would put Vermonters at risk of losing their subsidies. Now, with today’s U.S. Supreme Court ruling that federal subsidies can be offered in both state and federal health care exchanges, that fear is eliminated, and it’s clear we must immediately explore alternatives to Vermont Health Connect,” Scott said.

Scott called for immediately looking into a regional partnership with nearby states, creating a state-federal hybrid system or simply shifting to the federal exchange.

“For far too long, Vermonters have been underserved and frustrated by this $200 million system. Now that the fear of losing subsidies is no longer a valid argument, we must find the best path to affordable, accessible health insurance for every Vermonter,” he said.

But Lawrence Miller, Shumlin’s chief of health care reform, said Thursday’s ruling does not change the administration’s thinking and officials will continue to work on VHC.

“I think we’ve been clear that going to the federal exchange would still have substantial costs and complications for Vermonters. We would still need to figure out a way to deliver Vermont premium assistance because that’s not a part of the federal exchange,” Miller said.

Vermont is just one of two states that offer state-level financial assistance for customers on the exchange.

Miller said the state would still need to improve VHC even if the state moved to the federal exchange because it administers the state’s Medicaid program, including eligibility and enrollment. And, Miler said, insurance carriers in Vermont would have to devise a new integration model with the federal system.

Lawrence Miller

Lawrence Miller

“It would add substantial cost and complication. That is why we will still remain focused on the work at Vermont Health Connect and getting the level of service to what Vermonters expect,” he said.

Miller said he is glad the uncertainty brought about by the challenge has been settled.

“I’m very pleased with the decision. I think it’s the right decision,” Miller said. “The surprise really was when they took it, in my mind, and that raised a significant amount of uncertainty. If two more justices had seen it the way [Justice Antonin] Scalia (who wrote the dissenting opinion) did a lot of Americans would be having a very bad day.”

neal.goswami@timesargus.com

Shumlin claims exchange victory

WINOOSKI — Gov. Peter Shumlin and his health care reform team said Monday they have met a key deadline in implementing a core function to Vermont Health Connect and plan to continue improving the online health insurance marketplace through the fall.

“Having Vermont Health Connect work as it was designed to is the best possible outcome for Vermont. There’s no question that the biggest challenge that we’ve faced since we launched is change-of-circumstance,” Shumlin said at a news conference Monday. “We set a deadline of today … and I’m pleased to announce that this team behind me and some who aren’t here have delivered.”

Shumlin said the upgrade of the site to include change-of-circumstance, the ability for customers to have their personal information changed online, meets the first of two self-imposed deadlines he laid out in March as he faced mounting pressure about the exchange’s performance. The upgrade, which is still being phased in by the administration, will allow customer service representatives to make changes to consumers’ accounts in an automated way.

The process until Monday required staff to make manual changes to accounts and sometimes included more than 20 different people to complete the process, according to Cassandra Gekas, operations manager for the exchange. Now, staff will be able to condense what was up to a two hour total process — and because of backlogs could take months to complete — should take about 10 minutes and be reflected on users’ accounts at the next billing cycle.

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Chief of Health Care Reform Lawrence Miller speaks to reporters Monday while Gov. Peter Shumlin and other state officials look on.

“It means that we now have the capability, the tool, to be able to change your circumstance when things change for your insurance. And the outcome of that, as we get it up and running, will be a much smoother system that has been evading us since we launched,” Shumlin said.

Shumlin promised the change-of-circumstance function would be operational by the end of May. He also promised that an automated renewal process would be in place by Oct. 1. The state’s main contractor, Optum, will now turn its attention to the second milestone, Shumlin said.

The promises in March followed a host of missed deadlines and technological setbacks since the exchange launched. The exchange, created under the federal Affordable Care Act, has never performed as expected and been a source of frustration for customers, the administration and lawmakers.

Shumlin said in March that failing to meet the goals would result in the state transitioning to an exchange run by the federal government, or perhaps a state-federal hybrid model. Shumlin said Monday his administration would continue to work with Optum and the two insurance carriers — Blue Cross Blue Shield of Vermont and MVP Health Care — that offer plans on the exchange to improve the site.

“There is no better solution for Vermont than to have our website work. Full stop. If there were the ability to partner with other states or state to solve our problems, we would have done that already,” the governor said. “We have been … incredibly frustrated by getting to this point and the point we need to be at for enrollment Oct. 1. But the best outcome for Vermont is to have their own website work and that’s what I will continue to try to achieve.”

The change-of-circumstance function is only being partially unveiled, however. For now, customers will need to continue to call customer service staff or fill out an online form to request a change to their personal information. The ability for customers to make their own changes online will not be allowed until October, officials said.

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Shumlin admin to offer all-payer waiver request by end of June

MONTPELIER — Gov. Peter Shumlin says the state’s preliminary application for an all-payer waiver to level reimbursements to health care providers among all payers will be submitted by the end of June.

A universal, publicly-financed health care system is off the table. And Shumlin’s grand plan to pump additional funds into Medicaid through a $90 million payroll tax was ignored by lawmakers. But the administration has been making steady progress on another major reform in health care — changing the payment structure.

An all-payer waiver will allow the state to move forward with an ambitious plan to eliminate the current fee-for-service payment model that pays providers for each procedure and replace it with a system that pays providers on the quality of care they provide and the health outcomes of their patients.

Gov. Peter Shumlin

Gov. Peter Shumlin

“This is taking Medicare, Medicaid, private pay, in other words our entire payment system, and moving it to one where we literally pay our providers for keeping us healthy and giving them skin in the game,” Shumlin said in a recent interview. “It’s a revolution in the way we pay for health care. They get paid for keeping you healthy not for the number of things they do to you.”

State officials say if Vermont obtains the waiver from the federal Centers for Medicare and Medicaid Services, all insurance plans will pay the same amount and providers will have an incentive to work collectively to have the best health outcome that is not paid for based on the number of tests and procedures performed.

Currently, Maryland is the only state operating under an all-payer waiver, and has been doing so since the late 1970s. But Maryland’s system only sets Medicaid rates for hospitals. In Vermont, the goal is to take it further and include primary care providers and specialists as well as hospitals.

“What we’re talking about in Vermont is doing it with everybody, including Medicare, which is, of course, where the bulk of our money is,” Shumlin said. “It really is a very, very significant conversation.”

Officials with CMS will visit Vermont in the next couple of weeks to work with state officials on its application. The process requires rolling at least two waivers into one document that the state and federal government can agree on. Shumlin said his administration will have the document completed by the end of June, and the state should have an idea this fall whether the project is feasible.

Vermont currently has a Medicaid waiver to spend federal matching dollars outside of more rigid federal regulations. That waiver, known as the global commitment waiver, has been around since the administration of former Republican Gov. James Douglas, but it expires at the end of 2016.

The state’s application will also include a Medicare waiver that will allow it to spend Medicare funds outside the current regulations. However, “In no way does the state take control of Medicare money,” says Al Gobeille, chairman of the Green Mountain Care Board, the state’s health regulatory body.

Al Gobeille

Al Gobeille

“They are such substantially different waivers. What Medicare would be willing to do is relax its payment rules so we could tell them ahead of time how we’re going to do our rules and set our standards of care to meet their measures,” he said.

Completing the state’s preliminary application will only begin a long process of reforming the health care payment system in Vermont, Gobeille said. Once the state and federal governments come to terms, physicians will also have to buy in. Gobeille said the will take its plan to providers and ask them, “What do you think?”

“That begins a whole process of making sure that this is a good idea,” he said.

There are plenty of ways the project could crumble, though, both Shumlin and Gobeille said.

“My take is we’re going to negotiate with the federal government. There’s a possible chance that we could walk away and then maybe next year we try again. I’ve been clear with the governor and the legislature that if we don’t get something that’s a good idea … for both sides then we should exercise caution,” Gobeille said. “I don’t know if this is a good idea or bad idea yet until I know what the federal government is willing to do.”

Shumlin said he is worried about the ability to level out payments from all payers in a way that is fair.

“It could fall apart … at any time because it’s all fine to have everybody sitting around and agreeing that the current system is broken and we’ve got to fix it. The fight’s going to come when start talking about who gets paid what,” he said.

The state’s health care systems — hospitals and their subsidiaries — have varying interests based on their size and location. Shumlin said balanced those interests will be difficult.

“Here’s where this thing could fall apart — who is the person or people that controls the money? Let’s be honest, if it’s the big hospitals you lose all of the little folks. If it’s the little folks, the big people distrust. So, we have a huge project ahead to find an objective, transparent, trustworthy process that everyone can believe in or it will never work,” the governor said.

Reforming the payment system is crucial, though, to bending the cost curve in health care, he said.

“We’re all dead if we don’t get this one right because it will bankrupt us,” Shumlin said.

neal.goswami@timesargus.com

Rate increases sought by BCBS and MVP

MONTPELIER — The state’s two health insurance providers offering individual and business plans on Vermont Health Connect have submitted requested rate increases to the state for next year.

Blue Cross Blue Shield of Vermont and has requested an 8.4 percent increase in rates, while MVP Health Care is asking for a 3 percent average rate increase, according to the Green Mountain Health Care Board, the state’s regulatory body for health care issues.

In its filing with the GMCB, BCBS said state and federal mandates are a significant reason for the rate increases for its federally qualified health plans, as well as rising medical and pharmaceutical costs.

“In the absence of mandated changes associated with the Affordable Care Act, a 5.3 percent increase would have been requested,” BCBS wrote in its filing.

Actual rate increases, depending on health plans, range between 4.7 percent and 14.3 percent for BCBS. The changes will impact about 41,000 customers and amounts to about $29.4 million in higher premiums, according to the filing.

“We recognize that this increase is likely to be difficult to absorb for many individuals and small businesses who receive their coverage through qualified health plans, and we have done everything we can to reduce it, without risking access to quality care in the state,” BCBS President and CEO Don George said in a statement. “Unfortunately, a key factor contributing to premium growth has not changed. The Medicaid and Medicare cost shift continues to burden privately insured Vermonters with a disproportionate amount of health care cost increases.”

Increases requested by MVP, meanwhile, range between a decrease of 1.8 percent and an increase of 27.3 percent. The 27.3 percent increase is for the company’s catastrophic health plan.

MVP has a much smaller customer base, however, so the changes will impact 3,324 customers and lead to $951,000 in higher premiums paid.

Gov. Peter Shumlin on Monday said the increases are higher than he would like. But the increases sought for health plans on Vermont Health Connect, the state’s online health insurance marketplace created under the federal Affordable Care Act, are lower than would be expected for plans outside the exchange, he said.

“Let’s be honest, that’s going to look good compared to what businesses are used to,” he said.

Part of the increase should be attributed to the so-called cost shift, the governor said, where private insurance picks up the cost of low payments to providers by Medicaid and Medicare.

“We keep kicking the can down the road on Medicaid, so the cost shift happens to everyone paying for insurance, including the exchange. That’s private insurance,” Shumlin said.

Lawmakers, who wrapped up the first half of the legislative biennium on Saturday, rejected Shumlin’s plan to institute a 0.7 percent payroll tax on Vermont businesses to address the cost shift. The plan would have raised $90 million that would have been matched by $100 million in federal funds. That money would have allowed the state to boost Medicaid payments and ease the burden on private insurance.

Two public hearings will be held by the GMCB at the State House this summer. The public can comment on the MVP request on July 28 and those wishing to comment on the BCBS request can do so on July 29. The board will make a decision by August 13 on the rates that will take effect Jan. 1, 2016.

neal.goswami@timesargus.com

Capitol Beat with the Governor 5-15-15

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Gov. Peter Shumlin and Vermont Press Bureau chief Neal Goswami chat about the end of the session and the bills that are still in play.

Gov. Peter Shumlin on the Capitol Beat podcast Friday, May 15, 2015.

Gov. Peter Shumlin on the Capitol Beat podcast Friday, May 15, 2015.

Capitol Beat with the Governor 5-8-15

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Gov. Peter Shumlin discusses  end-of-session issues that remain unresolved, the possibility that lawmakers will vote to remove the state’s philosophical vaccine exemption and the arrest of Franklin County Sen. Norm McAllister on sex charges.

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RFK Jr. and Vermont moms make their cases on vaccines

MONTPELIER — A prominent member of the country’s most storied political family testified against the elimination of the state’s philosophical exemption for vaccines Tuesday, accusing the Centers for Disease Control of corruption as he made his case to lawmakers.

Robert F. Kennedy Jr., the son of the slain former U.S. senator, attorney general and presidential candidate, told members of the House Health Care Committee that he supports vaccination. But he said some vaccines that contain thimerosal, a mercury-containing compound in some vaccines, can cause harm in children.

The CDC, Kennedy said, which determines which vaccines children should receive, has not done a proper job of protecting them and has bowed to pressure from pharmaceutical companies. He said the trillion dollar industry spends twice as much on lobbying as any other industry.

“I’m pro-vaccine. I’ve had all six of my kids vaccinated,” Kennedy told the panel. “I think we ought to have state and federal policies that maximize vaccine coverage of the population but I think we have to begin the process by making sure the vaccines are safe, efficacious and that the regulatory agency which recommends vaccines … and monitors them has integrity and credibility and, unfortunately, that is not the case at the moment.”

Robert F. Kennedy Jr. at the Vermont State House on Tuesday, May 5, 2015.

Robert F. Kennedy Jr. at the Vermont State House on Tuesday, May 5, 2015.

Kennedy, who received a raucous standing ovation from some people after completing his testimony, has been an environmental activist for three decades and has worked on the vaccine issue for the past 10 years. He spent most of his 15 minutes before the committee denouncing the CDC’s oversight of vaccines.

“CDC is a troubled agency. There’s been four separate, scathing federal studies about CDC,” he said. “All of them together and separately paint a picture of an agency that has become a cesspool of corruption.”

Kennedy accused the agency of manipulating studies to show that vaccines are more effective than they are, and that they do not cause harm.

“You could design an epidemiological study that shows that cigarettes don’t cause cancer or sex didn’t cause pregnancy. You just get rid of all the pregnant people or you get rid of all the people who have cancer and then you present your study,” he said. “That’s what CDC has been doing with these nine epidemiological studies that they point to.”

He also faulted Congress for creating a “shield” for pharmaceutical companies in 1989 “that suddenly made vaccines very profitable,” causing an increase in the number of recommended vaccines by the CDC.

“When I was a kid the vaccines were not profitable. They were not profit centers for the company. They were almost a civic duty. But now vaccines can add revenue of a billion dollars a year for some of these companies and there is tremendous pressure to add these vaccines to the schedule,” he said. “Most of the people who sit on those committees are vaccine industry insiders. Many of them, if not most of them, have direct financial stakes in the outcome of their decision to add the vaccine to the schedule.”

Robert F. Kennedy Jr. speaks to reporters at the Vermont State House.

Robert F. Kennedy Jr. speaks to reporters at the Vermont State House.

“What’s very difficult is for the people of our country or the parents of Vermont to believe that those decisions are being made exclusively with the health of their children in mind,” Kennedy added.

Kennedy said the philosophical exemption in Vermont and other states is important because other protections and avenues of recourse no longer exist.

“The Congress has taken away jurisdiction in federal and state courts of any case against the vaccine industry so nobody can sue them. There’s no discovery, no depositions, there’s no class actions, there’s no documents,” he said. “All those things that protect us are gone. The only thing left that protects that child from that company, the only barrier standing, is the parent. And now we want tot make the parent away.”

Kennedy told reporters after his testimony that parents should vaccinate their children with mercury-free vaccines.

In Vermont, six vaccines are required for children to attend school, including ones for polio, Hepatitis B, measles and pertussis, according to Christine Finley, the Vermont Department of Health’s Immunization Program chief.

Currently, all 50 states allow medical exemptions. All but two states allow religious exemptions and 19 states have philosophical exemptions. Only Mississippi and West Virginia have neither religious nor philosophical exemptions.

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Vaccine debate heats up with a star witness

MONTPELIER — Action in the House on a bill that seeks to remove the state’s philosophical exemption for vaccines will be delayed until next week while a House Committee takes testimony on the issue.

Dylan Giambatista, chief of staff for Democratic House Speaker Shap Smith, said the House Health Care Committee will take testimony on Tuesday and Wednesday, and possibly Thursday. Currently, the committee is scheduled to hear from state health officials, medical professionals and advocates on both sides of the vaccine issue.

One of those advocates will be Robert F. Kennedy Jr., the son of former presidential candidate, U.S. attorney general and New York. Sen. Bobby Kennedy. Kennedy, who has testified around the country against forced vaccination, is scheduled to meet with Gov. Peter Shumlin Tuesday before providing testimony to the Health Care Committee, according to Kevin Ellis, a Montpelier-based lobbyist working to retain the state’s philosophical exemption.

Robert F. Kennedy Jr.

Robert F. Kennedy Jr.

Kennedy’s views and comments about vaccinations have been somewhat controversial. Last month he compared vaccination to a holocaust. And he has linked vaccinations with autism. The Journal of the American Medical Society has stated there is “no harmful association” between the measles, mumps and rubella vaccine and autism.

Shumlin spokesman Scott Coriell said Monday that Shumlin was asked to meet with Kennedy Tuesday and was told the governor “would probably have time in the afternoon to meet for a few minutes.” That meeting will not be open to the public, according to Coriell, and will not impact Shumlin’s views.

“The only voices that matter to the governor on this debate and any other are those of Vermonters,” he wrote in an email.

Ellis said he does not expect Kennedy’s recent comment to detract from his testimony.

“He’s been right on everything that matters,” Ellis said. “I think he apologized. We all make mistakes in the passion of the moment. He’s an important voice in the debate and it’s a debate that we need to have.”

Advocates in favor of removing the state’s philosophical exemption are also slated to be at the State House Tuesday. A group of Vermont mothers and grandmothers are holding a news conference Tuesday afternoon.

Passionate debate over the issue of vaccine exemptions was reignited earlier this year when Sen. Kevin Mullin, R-Rutland, introduced a bill to remove the right of parents to decline vaccinations for their children for philosophical reasons. It would also prevent students who are not vaccinated from attending school. A medical exemption and a religious exemption would remain.

That bill did not move, but Mullin and others were able to attach legislative language to another bill dealing with a disease registry. The bill, which included removing the philosophical exemption, passed the Senate on an 18 to 11 vote.

Sen. Kevin Mullin

Sen. Kevin Mullin

The bill as amended by the Senate has since languished in the House for nearly two weeks. The House postponed action on it until May 6, but that will now be pushed back further, Giambatista said, to what is expected to be the final week of this legislative session.

“I don’t think it’s going to be this week. It would be next week at the earliest, so it’s going to be down to the wire on the clock,” he said. “We’re trying to do our due diligence and have our opportunity for discussion.”

The Senate passed a similar repeal of the philosophical exemption in 2012, only to see it squashed by the House. Smith, whose wife is a physician, supports repealing the exemption, but it remains unclear if there is enough support in the House to advance it.

“He shares that with both sides on the issue. He is very clear on this issue,” Giambatista said. “The conversation is going to be ongoing.”

The speaker has met with both proponents and opponents of removing the exemption. Both sides will have a chance to testify before the House Health Care Committee this week.

“In terms of support levels, I don’t know. It’s a difficult issue to call because both sides are well-organized,” Giambatista.

Shumlin has been a supporter of keeping the exemption in place, but has indicated a willingness in recent weeks to entertain the debate. Coriell said Monday that Shumlin wants to give the law he signed in 2012 time to work.

That law requires parents or guardians to sign a form from the Heath Department acknowledging they have “reviewed and understands evidence-based educational material provided by the department of health regarding immunizations, including information about the risks of adverse reactions to immunization.”

The law also allows students to remain in school without required vaccines for up to six months if they are in the process of receiving them.

“The governor supports the law he signed two years ago and thinks we should give it a chance to work. If the Legislature wants to debate this issue further, he is open to that debate,” Coriell said.

neal.goswami@timesargus.com

Shumlin defends late budget push

MONTPELIER — Gov. Peter Shumlin said Friday he is asking lawmakers to cut an additional $10 million from the budget because they have rejected his proposal to institute a payroll tax to help pay for Medicaid costs.

Shumlin summoned the chairs of Senate money committees Wednesday — one day before the Senate took up the annual budget bill — to tell them they needed to cut more and tax less. The move frustrated lawmakers who are grinding toward adjournment, which is to come in mid-May.

On Thursday, administration officials presented a list of $8 million in further cuts to the Senate Appropriations Committee and made clear the third-term Democrat did not favor their tax plans.

Gov. Peter Shumlin speaks at a recent State House news conference.

Gov. Peter Shumlin speaks at a recent State House news conference.

“I really feel strongly that the tax packages being contemplated in this building will hurt our economy and hurt Vermonters,” Shumlin said in an interview with the Vermont Press Bureau on Friday. “I believe that the current budget framework needs to cut more and tax less.”

At the heart of the matter, Shumlin said, is how lawmakers have chosen to fund Medicaid case loads, which expanded under the federal Affordable Care Act to the tune of $16 million. The governor’s budget proposal used a 0.7 percent payroll tax on Vermont businesses to raise $90 million to cover that cost as well as to boost payments to Medicaid providers.

Lawmakers have rejected that, however, and funded Medicaid case loads through various taxes. But Shumlin, while now acknowledging his plan is unlikely, wants lawmakers to cut deeper rather than raise taxes.

“That idea has been an uphill slog and it looks like it’s possible that it may not come to fruition,” he said. “Unless they suddenly … see the light, which doesn’t seem extraordinarily likely, but I’m still hopeful, we have a $16 million budget challenge that we didn’t have, that we had taken care of.”

Shumlin said his proposal created an ongoing, dedicated source for Medicaid. Lawmakers, meanwhile, have created a host of new taxes to balance the general fund, he said.

“They want to take away your home mortgage deduction because you bought a home, they want to take away your charitable deduction because you want to support charities in your community, they want to take away the catastrophic health care deduction,” he said. “They want to tax soda and everything else with sugar in it because they say that drinking that stuff isn’t healthy for you, which it probably isn’t, but they also want to tax water. Tax water? Really? I thought you just said you shouldn’t drink sugary things, now they’re saying we’re going to tax water.”

Lawmakers are not amused with the governor’s late push to adjust their work. House Majority Leader Sarah Copeland Hanzas, D-Bradford, noted that lawmakers used the same amount of new revenue to support the general fund as Shumlin did in his proposal, but their challenge was even greater since the state saw an additional $18 million revenue downgrade after his budget address.

“We closed the $113 million budget gap with the same $35 million that the governor closed his $94 million gap. The same amount, not the same kind of revenue. So, to have the governor suggest that we are spending too much and raising too much in taxes is really perplexing,” she said. “I don’t know where they’re doing their math, but $35 million is $35 million.”

Rep. Sarah Copeland Hanzas

Rep. Sarah Copeland Hanzas

Hanzas said the governor should have made his pitch earlier — before the House passed its budget and sent it to the Senate.

“Where were you on Jan. 20 because it’s three months later and we’ve been through the painful process of vetting all of our painful priorities,” she said. “We would have appreciated them in January, not so much now.”

House Appropriations Committee Chairwoman Rep. Mitzi Johnson, D-South Hero, echoed that sentiment.

“It’s frustrating that he’s had opportunities for the last three months to weigh in on the budget and we don’t have a balanced budget proposal from him. He’s choosing to sort of nit-pick at different things,” Johnson said.

Both Johnson and House Speaker Shap Smith said Friday that the House-passed budget does fully fund the Medicaid case loads, but does not do it the way Shumlin sought.

Shumlin dismissed criticism of his timing, saying previous governors have also pushed for priorities late in the process.

“I don’t know where they’ve been. I’ve served under [Former Gov. Howard] Dean, [former Gov. Jim] Douglas, and I cannot remember as a legislative leader right before we’ve passed the budget not having the governor sit down with us and explain their concerns about budget and taxes. That’s what governors do. So, I understand it’s a time of year where folks get emotional,” Shumlin said.

Late-season requests are part of the budget process, Shumlin said.

“Folks get frustrated this time of year, I understand that, and I’m sympathetic to it. I’ve been on both sides of it in the governor’s office and the legislative leadership end of it,” he said. “The only thing I want to point out is this is not unusual and we shouldn’t be fearing frustration we should be fearing raising taxes on Vermonters at a time when they’re having a difficult time paying their bills, and we should be fearing passing a budget that isn’t sustainable for the years going forward.”

“I believe that my judgement is correct. We should cut $10 million more from the budget and not raise taxes on Vermonters by that $10 million,” Shumlin added.

The Senate appeared ready Friday to reject most of the $8 million in cuts the governor proposed this week. A $1.3 million savings pharmacy costs looked likely, but bigger ticket items, including an additional $2.8 million in labor savings on top of the $10.8 million Shumlin previously requested, appeared to lack support.

neal.goswami@timesargus.com

Capitol Beat with the Governor 5-1-15

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Gov. Peter Shumlin chats with Vermont Press Bureau chief Neal Goswami about his budget disagreements with lawmakers.

House votes to maintain safeguards, fends off repeal of Act 39

MONTPELIER — The Vermont House on Wednesday voted to maintain safeguards in place under the state’s aid-in-dying law after defeating an effort to repeal it entirely.

On a 83 to 60 vote, the chamber defeated an amendment by independent Barre Rep. Paul Poirier to repeal Act 39, which was signed into law in 2013. The law allows terminally ill patients to receive a prescription for lethal medication.

Any patient seeking to take advantage of the law must live in Vermont and have a prognosis of less than six months to live. A doctor must also find that the patient has the capacity to make the decision to obtain the medication voluntarily.

Some provisions, however, are set to expire in July 2016 if the law is not amended. Among those are that a second doctor must concur on the prognosis, and a doctor must tell the patient in person and in writing about the nature of the diagnosis and effects of the lethal medication.

Also set to expire is a requirement that the patient must make two oral requests for the lethal drug at least 15 days apart followed by a written request with two witnesses attesting that it was made voluntarily.

Those protections built into the law are scheduled to expire because two former senators had made that a condition of their support for the law.

The House voted by voice Wednesday, after defeating Poirier’s amendment, to repeal the sunset and maintain the safeguards. The Senate approved the measure last month after fending off similar efforts to repeal the underlying law.

Poirier said Wednesday his objection to the law is philosophical.

“I don’t believe that the state of Vermont, as a government, has the right to take away the life of another human being,” he said on the floor in support of his amendment. “State sponsored end of life measures could lead us to a very, very slippery slope. Where does it end?”

Poirier said the state’s palliative care options have improved. He said all 14 hospitals in the state, as well as the Vermont Veterans Home and most nursing homes, have approved policies disallowing the aid-in-dying option for patients in their care.

“We live in a society where we respect life. We respect life even for those who are suffering,” Poirier said.

Rep. Anne Donahue, R-Northfield, was more forceful in her attacks on what she labeled an “incredibly badly written law.”

She said most of the protections originally considered by the Legislature in 2013 were whittled away to secure the support of enough lawmakers to pass it. Among the things tossed aside, she said, were most data gathering and reporting requirements.

“How, today, can we say it’s working as intended?” Donahue said. “We don’t have the information.”

Rep. Sandy Haas, P-Rochester, said the House Human Services Committee amended the Senate version of the bill to require more data gathering and reporting. Under the changes, which the House approved Wednesday, the Department of Health will be able to identify which patients fill prescriptions under the law. And beginning in 2018, it will have to generate a biennial statistical report of information collected.

“We believe that this will increase public confidence that the law is being properly followed,” Haas said.

Donahue further charged that doctors were being shamed into participating in the voluntary program and patients are being bullied into requesting the medication. She also said the law lacks an informed consent provision.

“It is a myth that doctors and other providers do not have to participate in any way if they don’t want to and it is a myth that patients are not being pressured to consider using a prescription,” she said.

Haas, meanwhile, said state law already requires informed consent for all health care decisions so it was not necessary to include it in Act 39. And no complaints have been filed with the attorney general’s office or the Department of Health, she said.

The legislation is up for final approval in the House on Thursday. Additional amendments are expected.

neal.goswami@timesargus.com

Capitol Beat 4-27-15

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Vermont Press Bureau chief Neal Goswami and VPB reporter Josh O’Gorman talk about the developments last week in the State House, including education, health care, vaccines and gun legislation.

Capitol Beat with the Governor 4-24-15

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Gov. Peter Shumlin and Vermont Press Bureau chief Neal Goswami discuss competing health care plans, the governor’s intention to sign gun legislation and the merits of lowering the state’s sales tax by expanding it to services.

Shumlin says he will sign gun bill

MONTPELIER — Gov. Peter Shumlin said Friday he intends to sign a gun bill passed by both chambers after it is reviewed by his administration’s legal team.

Shumlin, a third-term Democrat, had remained noncommittal through Friday on whether he would sign the measure that cleared its final legislative hurdle on Thursday. The bill awaiting the governor’s signature makes it a crime at the state level for some convicts to possess a firearm. It also requires that the state report to a federal database the names of people found by a court to be mentally ill and a danger to themselves or others.

The Senate concurred Thursday with changes to S.141 made by the House that removed a waiting period of 18 months for those reported to the federal database to apply to have their names removed. The waiting period was a concern, according to Shumlin, who said Friday he was glad to see it removed.

After review Shumlin said he intends to sign the bill.

“I always like to read the bills and make sure that what I’ve been told is actually in there. But, if what I have been told is in that bill I will sign it,” Shumlin said in an interview Friday. “We always have our lawyers review them.”

The bill is a far cry from what was initially proposed. The original legislation, backed strongly by Gun Sense Vermont, included an expansion of federal background checks. Gun rights advocates turned out in force to a public hearing and the background check provision was scuttled.

But advocates of the legislation were able to keep the bill’s other components alive and guide it through the legislative process. In the end, one of the groups that opposed the bill most, the Vermont Federation of Sportsmens Clubs, the National Rifle Association’s state affiliate, dropped its objections.

Shumlin said the bill was scaled back enough for him to drop his own objections.

“I am very happy that the bill is a shadow of the bill that I objected to in the beginning. [Senate Judiciary Committee Chairman Dick] Sears and others took out the parts that I really objected to. I think, now, most reasonable people would agree that it makes some common sense changes, similar to the kind of changes that I voted for when we didn’t allow … folks to take guns to schools,” the governor said.

While Gun Sense Vermont has indicated they view the legislation as a first step, Shumlin said he is no hurry to revisit the debate on expanded background checks.

“I feel that Vermont’s gun laws serve us well. I’d probably feel differently if I was the mayor of Chicago or the mayor of New York where you have all kinds of challenges. But, we in Vermont have a culture of using guns to manager our natural resources. We have a culture of hunting and caring for our natural resources that has served us well. We have a traditional respect for guns,” Shumlin said. “It’s different in a small rural state where you have a culture like Vermonters where we take care of each other, look out for each other. So that’s just what I feel and you’re not going to change my feelings.”

A full story will appear in Saturday’s editions of the Barre-Montpelier Times Argus and the Rutland Herald.

neal.goswami@timesargus.com

Shumlin apologizes for suicide remark

MONTPELIER — Gov. Peter Shumlin, facing more questions from reporters about the poor operation of Vermont Heath Connect, let loose his frustration Tuesday with a joke alluding to suicide during a news conference.

The governor last month promised that a key function missing from the state’s online health insurance marketplace would be in place by May 31. But with the self-imposed deadline fast approaching, the governor has faced continuing questions about what happens if the deadline is missed.

Last month, Shumlin promised that the so-called change of circumstance function, the ability for customers to change their personal information in their online accounts, would function by May 31. An automated renewal process was promised by the end of October. Missing either those deadlines would result in the administration beginning the process of switching to an exchange operated by the federal government, or perhaps a state-federal hybrid.

But the governor has seemed to back away from the first deadline, saying his administration would determine how to move forward in October — well after the initial May 31 deadline. House Speaker Shap Smith said last week that he wants to begin the process of moving away from Vermont Health Connect in June if change of circumstance is not working.

Asked several times what he intends to do on June 1 if change of circumstance is not working, the governor offered an off-color response.

“I’m going to find a high building,” Shumlin said. “I’m at the end of my rope. I don’t think the fifth floor [of the Pavillion Building where his office is located] is high enough.”

The governor’s office later issued a statement from the governor apologizing for the remark.

“Using that saying was an inappropriate way to express my frustration. It was insensitive and I apologize,” the governor said in the statement.

The governor’s remarks followed an emotional debate on the House floor last week over gun legislation in which mental illness and suicide were discussed.

Earlier in his exchange with reporters on Tuesday, Shumlin cautioned against creating conflicts over the deadline.

“I check on this with my team every day, sometimes three times a day. We all really want this to succeed. But, let’s focus on what we’re doing here. We’re on track. We’re optimistic that we’re on track. Why are we trying to create a fight over something that we may well never have to fight about,” he said.

“Let’s not create conflicts that we don’t need to have. I’m focused on trying to get the job done and I know the Legislature joins me in wanting the exchange to work,” Shumlin added.

Asked why he created the May 31 deadline in the first place, Shumlin said he wanted to ensure the public that his administration would seek other options if those lacking functions could not be completed.

“Because I feel like we’re all fed up. We’re all frustrated. Listen, this has been the most frustrating and disappointing experience of my public life. I’ve told you a million times that Vermonters and I are fed up. It’s incredibly frustrating,” he said.

neal.goswami@timesargus.com