Category Archives: Health Care

Video: Vermont This Week on Vermont PBS

Bureau chief Neal Goswami joins moderator Stewart Ledbetter, Local 22/Local 44 reporter Steph Machado and Tim McQuiston from Vermont Business Magazine on this week’s Vermont This Week panel.

HEADLINES: State Economists Project Major Stimulus From Oil Decline; Gasoline Price Disparities In Spotlight; Bipartisan Group Proposes New Health Exchange; Auditor Questions If Ski Resorts Pay Fair Share; Senate Leaders Introduce Gun Bill; Sugar-Sweetened Beverage Tax Is Back.

Browning files public records request bill

MONTPELIER — A lawmaker who sued Gov. Peter Shumlin for documents related to his now-shelved single payer health care proposal has introduced legislation that would require the documents to be revealed in the future in similar situations.

Rep. Cynthia Browning, D-Arlington, plans to introduce a bill to require greater access to public records under certain conditions and require judicial rulings on appeals of denials of access within a certain period of time. Browning said the legislation is needed based on her own legal case against the governor.

Browning, though she lost her case in superior court, maintains the administration inappropriately used executive privilege to prevent the release of information prior to his announcement on Dec. 17 that he was no longer pursuing a universal, publicly financed health care system because of its cost.

Rep. Cynthia Browning

Rep. Cynthia Browning

“My understanding is that executive privilege is intended to serve the public by ensuring that government officials can have thorough and confidential discussions of policy alternatives. It is not intended to protect those officials from inconvenience or embarrassment. If a person
claims to believe in the principles of transparency and accountability they must uphold them when it is hard as well as when it is easy,” Browning said in a release Friday. “I think that in this case executive privilege was used to conceal the politically difficult facts related to how much the single payer plan might cost and how much taxes might have to increase to
finance it. Ironically, this concealment did not serve the Governor well politically with either supporters or skeptics of the plan.”

Browning’s bill contains several provisions, including:

— If reports or documents have been shared by executive branch staff with people who are not part of that branch or working for it outside of the presence of the governor, executive privilege would be waived.

— If an official or public agency is required by law to produce a report on a date certain and it is not produced it and the law is not amended to extend the date, any records related to that report cannot be covered by executive privilege.

— If a public records request is denied by the government a Vermonter can appeal that denial to Superior Court. The current statute requires that such an appeal receive a judicial ruling “expeditiously,” and that such dockets should be handled before other cases, but the word
“expeditious” is not given a time definition. The bill would define “expeditious” as 45 calendar days after the last brief filed by the complainant.

Browning said the Shumlin administration shared documents and reports with some legislators, including House Speaker Shap Smith when the governor was not present and still claimed executive privilege. She argues that executive privilege should not be extended to a separate branch of government.

Shumlin, according to Act 48, was originally supposed to release a financing plan for his health care plan in January 2013 but did not. Browning said the Legislature did nothing to enforce that deadline and the administration was allowed to withhold information. Browning filed a public records request to the administration in March 2014 seeking documents and reports. The Legislature did not act to extend the governor’s deadline in law until May 2014, she said.

Browning said Vermonters should be able to obtain materials when a report is overdue, even when the Legislature does not try to enforce the law.

The 45-day timeline for judicial rulings is needed to speed up the process of records request, Browning said. She filed her case on Sept. 4, 2014, but the judge did not issue a ruling until Dec. 10 — a span of 14 weeks. Browning said the length “does not meet a common sense definition of expeditious.”

Read the proposed legislation below:

Capitol Beat with the Governor 1-23-15

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Gov. Peter Shumlin and Vermont Press Bureau chief Neal Goswami discuss a recent revenue downgrade, the president’s support for paid sick leave, gun legislation introduced in the Senate and legislators’ efforts to scuttle Vermont Health Connect.

 

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House members pitch new exchange proposal

MONTPELIER — A bipartisan group of House members are pushing a new proposal to move the state away from Vermont Health Connect, but the consequences remain unclear if the state were to adopt the proposal.

On Thursday, Reps. Patti Komline, R-Dorset, Heidi Scheuermann, R-Stowe, Jim Condon D-Colchester, and Adam Greshin, I-Warren, called for the state to transition from Vermont Health Connect to a Supported State-Based Marketplace Exchange. Oregon and Nevada have adopted the hybrid state-federal model after their state-based exchanges faced significant problems.

Vermont’s exchange, which also experienced significant tech challenges and is still not fully functional, allows some individuals to sign up for insurance plans through the website. But other individuals and all small businesses are enrolling through a paper process. And users cannot currently make changes to their information online in an automated way.

Rep. Patti Komline

Rep. Patti Komline

Komline said by adopting the model used by other states the state could shed its IT woes while maintaining control of the plans offered, and without losing the ability to provide federal and state subsidies to help make insurance more affordable to Vermont residents.

“We can control the plans that we’re offering, but when it comes to handling the IT, we can call on healthcare.gov to do that,” she said. “The transition costs for Oregon was $7 million. They were able to use the grant money from the feds. It took them six months to make that transition and so far it’s gone very smoothly for them.”

“It’s a viable alternative. We’re not just playing political games with it, but it’s something that we can really do,” Komline added.

Condon said his goal is to provide Vermonters with a fully functioning insurance marketplace.

“Vermonters deserve a functioning insurance portal. They don’t have that yet, but citizens deserve the ability to be able to go online and get their business done and take care of this. It’s just not happening as well as it should be,” he said. “My own personal opinion is that we should have gone the fed way to begin with. I think it would have saved a lot of hassles.”

The federal government is not charging Oregon and Nevada, at least for 2015, for the use of the federal site. But, it could begin charging them 3.5 percent of the cost of premiums as it does for other states that fully use the federal exchange. With Vermont’s $200 million in premium spending, that would mean a $7 million tax for Vermonters in total.

Previous opposition to moving to the federal exchange included the likely scenario that Vermont would not longer be able to provide state-level subsidies, among other reasons. Massachusetts is the only other state to do so, and it is not clear if CMS would allow that to continue.

“A key point is that we keep our subsidies with this,” Komline told reporters Thursday. “The officials in Oregon and New Mexico and in Nevada are all saying that they’re covered. That they’re subsidies are fully covered.

But the Centers for Medicaid and Medicare, which oversees state and federal exchanges, has never before considered whether a state could continue to provide state-level subsidies through the hybrid model.

The state expects to spend about $8 million this year on operating the portion of Vermont Health Connect that deals with exchange plans. That cost would be gone under the proposal released Thursday, according to Komline.

But their plan does not address Medicaid, which also flows through the state exchange. Komline said the state’s Medicaid program would continue to be run by the state. Lawrence Miller, Gov. Peter Shumlin’s chief of health care reform, said Vermont Health Connect would continue to be needed and built out in order for the state to effectively manage the Medicaid program.

There would still be a savings to the state, Komline insisted.

And Scheuermann said state officials would work with the federal government to answer questions that remain unknown.

“These are the questions that we do want answered and we want to work with. But this is relatively new,” Scheuermann said. “We want to work with the feds to do that, both with regard to Medicaid and with regard to the state subsidies.”

Lawrence Miller

Lawrence Miller

Miller acknowledged Thursday that Vermont Health Connect’s “current operations are unacceptable.” But he said many of the functions needed for the state’s Medicaid program are also needed for the part of the exchange the proposal revealed Thursday would jettison to the federal site.

“It’s a viable alternative to the qualified health plan component. The concern, of course, is that Vermont Health Connect is also the Medicaid eligibility and enrollment engine,” Miller said. “It’s a question of how to accomplish multiple goals most effectively. It certainly address the qualified health plan issue, but the exchange is primarily, by volume and users, Medicaid eligibility and enrollment.”

Miller said the administration has already engaged with CMS in discussions of several options and will continue to explore the best path forward for the state.

“We’ve discussed everything with CMS. Nobody’s particular happy with where we are,” he said.

The legislation proposed Thursday calls for the administration to have a transition plan ready by March 31. Miller said the administration will be prepared to offer a formal response if the bill advances.

“We’re not waiting for the Legislature to make a decision about this. If this is passed we would have begun our groundwork well before,” he said.

The so-called change of circumstance function that is still not part of the exchange, which would allow automated changes to be made by users, is on track to be completed in April, according to Miller. He said the state will continue to ask its contractor, Optum, to complete that work. Other recent deadlines have been met by the company, he said.

“I would support continuing to complete the change of circumstance functionality because we need that for the Medicaid … eligibility, anyway. It’s not something we can just stop doing. We don’t have another way of doing Medicaid enrollment or redetermination. That is the path,” Miller said.

neal.goswami@timesargus.com

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Larson to leave DVHA in March

MONTPELIER – Department of Vermont Health Access Commissioner Mark Larson is stepping down from his post in March and will be replaced by Deputy Commissioner Lori Collins on an interim basis, the Shumlin administration announced Tuesday.

Larson has had a rocky tenure as commissioner. It included overseeing the botched rollout of Vermont Health Connect, the state’s online health insurance marketplace that is part of the federal Affordable Care Act.

Larson, a former state representative from Burlington and chairman of the House Health Care Committee, was eventually stripped of his oversight of the exchange in September of last year by Gov. Peter Shumlin. The site was taken offline by the state after the federal government raised concerns over its security and threatened to disconnect the state from a federal data hub.

Larson oversight role was taken over by Chief of Health Care Reform Lawrence Miller, Shumlin’s former Commerce secretary, who was first brought on in January 2014 to help the Shumlin administration right the ship after the botched exchange rollout in October 2013.

Larson was also chastised last year by Shumlin and legislative leaders after he offered misleading statements concerning an exchange security breach to the House Health Care Committee.

Mark Larson

Mark Larson

Still, Shumlin praised Larson’s work as commissioner in a statement Tuesday.

“Mark has worked as hard as anyone on my team over the last four years,” Shumlin said. “Mark led the Department through some challenging times, but no one cared more or tried harder to overcome those challenges so Vermonters could access affordable health care than Mark. Thanks to the work of Mark and others, tens of thousands more Vermonters are now insured. I appreciate his service and understand his desire to take some time to step back and explore new opportunities.”

Larson, in his statement released by the administration, acknowledged the challenges during his tenure, but also noted the decrease in Vermont’s uninsured population.

“The last three years have involved a historic transition in health care for Vermont and our country, and has not been without its challenges. I am proud of the fact that in Vermont we have reduced by half the number of uninsured Vermonters and are on track to significantly reform how Medicaid pay providers for health services,” Larson said. “I am proud to have been part of this tremendous effort. As the Department prepares to engage its next phase of work, it is time for me to move on to new opportunities. I look forward to stepping back to the role of citizen and witnessing the continued progress toward coverage for all Vermonters and more rational ways to pay for health services.”

DVHA, which oversees the state’s Medicaid program, implemented an expansion of Medicaid services available under the ACA. That resulted in thousands of Vermonters obtaining new coverage through Medicaid. The administration also highlighted DVHA’s role in the Blueprint for Health, which has allowed most Vermonters to receive primary care from an enrolled provider.

A search is ongoing for a permanent replacement, according to the administration.

Video: Capitol Beat on ORCA with Speaker Shap Smith

House Speaker Shap Smith sits down with Vermont Press Bureau chief Neal Goswami and VPB reporter Josh O’Gorman to discuss the first two weeks of the legislative session.

Capitol Beat podcast for 1-19-15

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On this week’s episode, Vermont Press Bureau chief Neal Goswami and VPB reporter Josh O’Gorman discuss Gov. Peter Shumlin’s budget, his education proposals and a study released Friday about legalizing pot in Vermont. Subscribe on the iTunes store to the Vermont Press Bureau’s podcasts.

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VIDEO: Gov. Peter Shumlin’s budget address

Watch Gov. Peter Shumlin’s budget address below:

PODCAST: Capitol Beat with the Governor 1-16-15

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Gov. Peter Shumlin sits down with Vermont Press Bureau chief Neal Goswami to discuss his budget proposal and a new study released Friday on legalizing marijuana in Vermont. Listen for the governor’s thoughts on tax increases, budget cuts and efforts to curtail health care and education spending.

Pot study finds $50 million in potential revenue

MONTPELIER — A study on marijuana legalization in Vermont released Friday has found that the state could net as much as $50 million in new revenue by taxing and regulating the drug, but it would come with some consequences and other expenses.

The report, called for in legislation signed into law last year, was completed by Rand Corp. and obtained by the Vermont Press Bureau Thursday. The study found that legalizing marijuana in Vermont could produce revenue ranging from $35 million to $50 million annually, based on myriad policy choices.

The calculation is based on tax models in Colorado and Washington, where marijuana is legal. In those states, assessments capture about 30 to 40 percent of the cost of marijuana and deposits it in state coffers. Continue reading

Text of Gov. Shumlin’s budget address

Shumlin calls for new payroll tax to boost Medicaid payments

MONTPELIER — Gov. Peter Shumlin is proposing a new, 0.7 percent payroll tax to boost Medicaid reimbursements, and is looking to close a $15 million tax loophole as part of an effort to balance the 2016 fiscal year budget and close a $94 million gap.

Shumlin, a third-term Democrat, will be outlining his budget proposal to a joint session of the Legislature this afternoon. His proposed budget calls for $5.62 billion in total spending, with $1.47 billion in general funds — that’s a 4.4 percent increase over current general fund spending. The proposal closes a projected $94 million gap, aides said ahead of the governor’s speech.

Newly appointed Secretary of Administration Justin Johnson said the proposed budget uses $12 million in one-time funds, down from $53 million in the current budget. And it reduces spending within the Agency of Human Services by about $21.7 million, and non-AHS spending by $22.2 million. There is a net decrease of 11 state positions, he said.

Gov. Peter Shumlin at least week's inauguration. (Photo by Jeb Wallace-Brodeur)

Gov. Peter Shumlin at last week’s inauguration. (Photo by Jeb Wallace-Brodeur)

Under the budget proposal, the state would see $15.5 million in additional general fund dollars through the use of a tax code change. A 2009 provision that allows filers who itemize deductions to deduct their prior year state and local tax bill would be eliminated. Officials say about 30 percent of taxpayers utilize the provision.

Part of the AHS reductions includes removing $6 million in base funding for the Low-Income Home Energy Assistance Program. There are no cuts to child protection services, according to aides.

“We have not at all compromised efforts around child protection,” Finance Commissioner James Reardon said.

The administration is looking to consolidate “public safety answering points,” where the Department of Public safety dispatches officers and takes 911 calls, from four to two. Rutland and Rockingham locations would consolidate, as would with Williston and Derby locations. That will save the state about $1.7 million, officials said.

The budget also proposes scaling back the recently enacted working lands program by $700,000, and finding $5 million in generic labor savings through discussions with the Vermont State Employees Association.

Meanwhile, the state hopes to see new revenue by providing additional prison beds to the U.S. Marshal Service. Doing so would require sending more Vermont prisoners out of state, though, so the net cost savings would be about $800,000.

The governor is also proposing a new, 0.7 percent payroll tax on all Vermont employers to boost Medicaid reimbursements to providers and reduce the so-called cost shift to private insurance. Health Care Reform Chief Lawrence Miller said current reimbursement rates have led to a $150 million total cost-shift.

The new payroll tax, which would take effect in January 2016, would net the state $41 million in new revenue from January through June. That would trigger $45 million in matching funds from the federal government. The Shumlin administration is proposing to use $55 million to bring Medicaid reimbursements from 60 percent of costs to 80 percent — the level at which Medicare reimburses providers.

The remaining funds would be used by the GMCB to continue cost containment efforts and bump payments with the Blueprint for Health program.

“That program has been going for a while now and they haven’t had a bump since Day 1,” Miller said.

Typically, the governor presents a budget after the Emergency Board meets to review revenue results and the economic forecast. This year, the budget has been proposed before that update.

Johnson said the administration is confident the proposed budget will hold up to a new revenue forecast next week.

“All the indications we have right now leave me, as the brand new secretary of administration, relatively comfortable with where we are,” he said. “I’m feeling like we’re in an OK place right now.”

A full story on Shumlin’s budget proposal and address to the to the Legislature will run in Friday’s editions of the Rutland Herald and Barre-Montpelier Times Argus.

VIDEO: House Health Care Jan. 13

Video from the House Health Care Committee hearing on Jan. 13:

Lawmakers reviewing health spending

The Senate Health and Welfare Committee is reviewing a Rand study today on current health care spending in Vermont and projected trends.

Review the data presented to lawmakers below:

 

Read the full report below:

Podcast: Capitol Beat with the Governor 1-9-15

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Gov. Peter Shumlin sits down with Vermont Press Bureau Chief Neal Goswami for the first Capitol Beat with the Governor podcast of the legislative session.

After being re-elected to a third term by lawmakers on Thursday, Gov. Peter Shumlin delivered his inaugural address amid protests over his decision to shelve a universal, publicly financed health care system because of its cost. Listen to this week’s episode to hear the governor address all of it.

Gov. Peter Shumlin records the Capitol Beat podcast on Friday.

Gov. Peter Shumlin records the Capitol Beat podcast on Friday.