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Action continues in the committee rooms with little time spent on the House floor. The Governor’s veto of the paid family leave bill was sustained on a vote of 99-51. In order to override a veto each chamber needs a two-thirds majority vote. I am deeply disappointed in this vote but will continue to find ways to support Vermont families.
The Health Care Committee continues to focus on workforce, affordability and accessibility. All three being intimately linked together. We are experiencing shortages in all professions from unlicensed personal care attendants and direct support professionals, to physicians - across all care units. A 2018 study found there will be 3,900 nursing vacancies in Vermont by spring 2020 – just around the corner. The situation in Vermont is not unique, these same issues are happening across the country. In Vermont the workforce crisis is driven by several factors: tight national and local labor markets, aging workforce, provider burnout, rising higher education costs, limited educational capacity, insufficient Medicaid rates and broader economic development challenges. The health care committee is taking testimony on how we license medical professionals, what background educators need, programs for student loan repayment and an expansion of telehealth, just to name a few focus areas, in an effort to turn the tide. I attended a meeting where Dr. Joshua Sharfstein, Professor of the Practice of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, provided a national perspective on Vermont’s health reform. He spoke of the widening gap between U.S. health spending and that of other countries and the decline in U.S. life expectancy. He discussed the limits of fee for service reimbursement, the current U.S. model, and how that model incentivizes expensive procedures, creates a tug of war between insurers and clinicians and rewards the healthcare system when our population is sicker. This is at the crux of Vermont’s efforts with the move to value based payments through our All Payer Reform. We have a statewide goal of improving quality of care and population health while limiting cost growth. At the center of our reform efforts is OneCare, Vermont’s accountable care organization. An ACO is a group of healthcare providers, including hospitals and doctors, who work together to provide high quality, coordinated care. One of the key known success factors for an ACO is the involvement of multiple payers - in Vermont’s model we are bringing together Medicare, Medicaid and commercial insurers. Early results show our efforts are working with patients reporting timely care, good communication and coordination. The Milbank Quarterly reviewed the reform efforts of four states and found that Vermont has “the most promising results” with fewer hospitalizations and monthly savings per person versus their comparison groups. The committees of jurisdiction will continue oversight of our reform efforts and I’m happy to provide more information to anyone interested. On a completely different note I co-sponsored a bill this year asking for a $500,000 increase to the Vermont Department of Tourism and Marketing promotional budget focused on encouraging out-of-state visitors to Vermont. This department unifies messaging from the various parts of the state and across the tourism sector into one cohesive message and shares that message to potential visitors across the country and around the world. There are many ways that tourism is economic development – it generates tax revenues, creates jobs and unlocks economic activity in rural communities. After manufacturing, tourism is the second largest contributor of out-of-state dollars to the state. Tax revenue generated from tourism equates to a savings of over $1450 for every Vermont household – any investment we make in tourism will benefit all Vermonters by bringing in more revenue. We are asking for this increase now because Vermont has decreased its investment in tourism promotion by 6% over the last 5 years – we need to reverse that trend and invest in Vermont. There are a few upcoming events that might interest residents: House Speaker Mitzi Johnson will be holding a community conversation at ArtHound Gallery Monday February 10th from 6pm to 7:30pm. The ArtHound Gallery is located at 21 Essex Way (across from the Essex Cinemas). Voices for Inclusion in Essex and Westford will present The Hate U Give on Wednesday February 12th at Essex High School from 6pm to 9pm. A dialogue will be held after the free screening. The next Essex Delegation Community Conversation is Saturday February 15th from 9am to 10:30am at Sweet Alchemy. This is a relaxed environment where we answer questions and have discussion on the topics important to residents. Hope to see you at one or all of these events. As always, don’t hesitate to reach out with questions or comments – Houghton.lori@gmail.com
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On Thursday January 23rd the House passed bill H107 a Paid Family and Medical Leave bill on a vote on 89 - 58. This legislation would provide 12 weeks of paid family leave or 8 weeks of family medical leave and would grow our workforce, attract young people, and support the lives of working Vermonters. Unfortunately the Governor vetoed this bill late Friday. The House and Senate will have override votes in the very near future. Two-thirds of members present in both chambers must vote to override a veto. If all members are in attendance, this is 100 of the 150 members in the House and 20 of the 30 members in the Senate. Vermont is one of 36 states that requires a two-thirds vote from both of its legislative chambers to override a veto. I have heard from no one who opposes this bill and I will continue to support this legislation as a mother, business owner and caregiver. Stay tuned.
This past week was quiet on the floor but not in committee rooms. House Healthcare testimony continued to focus on creating an affordable and accessible healthcare system. We took a deep dive into the recommendations of our Rural Healthcare Task Force and heard testimony from primary care doctors about the struggles they face. We agreed to try to tackle three constant and growing issues - shortage of nurses and doctors, access to specialists, affordability - by creating subcommittees. These are complex issues that require research, time and engagement with others outside of our committee. By breaking into subcommittees we can focus on these specific concerns and still have committee time to focus on our other priorities like addressing the governor's budget, focusing on our mental health system and addressing the various bills sitting on our wall. The Department of Mental Health released their 10 year plan for an integrated and holistic system. Although we only heard a brief overview we are encouraged simply by the title’s language - integrated and holistic. Our physical health and mental must be treated as one both in policy and payment. We also heard from many advocates on Mental Health Advocacy day. The people who experience mental health issues and those who are there to provide treatment and support persevere through stigma in an unjust system that lacks many basic resources. Until we achieve parity with physical and mental health our committee will keep pushing. If you’d like information or have feedback on the above or anything else, please don’t hesitate to reach out! Thank you for allowing me to be your representative in Montpelier. Below are a few upcoming events: Climate Caucus Public Forum, How can Vermont do its part to combat climate change - and why does it matter to you? Tuesday, February 4, 6 to 7:30 pm, Vermont Statehouse | Room 11 A Night with Mitzi Johnson, Vermont Speaker of the House Monday, February 10, 6:00 pm to 7:30 pm at Art Hound Gallery, 221 Way Community Conversations with your Essex Delegation Saturday, February 15, 9 - 10:30 am at Sweet Alchemy, Upper Main St Essex Pre-Town Meeting Overview of Merger Saturday, February 15, 1-3pm at Essex Middle School Cafeteria Light refreshments and supervised child-friendly activities* provided. *Please email ajanda@essex.org if you will need supervised child-friendly activities. Today the Essex delegation and our neighbors had a robust community conversation at The Nest with topics ranging from Brattleboro Retreat, the state’s bond rating, criminal justice reform, plastics and climate change - just to name a few of the interesting discussions. These conversations are offered in a friendly setting so residents can tell Legislators your wants and desires for yourself, the Essex community and the State. Our next event is planned for Saturday February 15th from 9:00 am to 10:30 am at Sweet Alchemy Bakery and Cafe. Come for the entirety or just a few minutes. Hope to see you there!
This past week in House Health Care we began our rural health discussion by hearing testimony from the Rural Health Services task force created with legislation last year. The task force was charged with creating an inventory of the current system of rural health delivery in Vermont, consider how to ensure sustainability, including financial, administrative and workforce barriers, identify ways to overcome these barriers to sustainability, identify ways to encourage and improve care coordination and consider the potential consequences of the failure of one or more rural hospitals in Vermont. We also had a group of primary care doctors testify on the challenges they face followed by attending a Green Mountain Care Board meeting of the same topic. One primary care practice has been recruiting for a doctor for 2 years, another for 6 years - with no luck. The committee will take a deep dive with the Rural Health Services Task Force into their recommendations including work force, telehealth, care coordination and revenue stability. The report and their presentation can be found here. Continuing our discussions from previous legislative years OneCare, Vermont’s accountable care organization (ACO) and a key player in our healthcare reform, presented during a joint session with House Health Care and Senate Health & Welfare. An ACO is a legal entity, comprised and led by providers that take accountability for both quality and costs of care for a defined population. You may be attributed to Vermont’s ACO, OneCare, if your primary care doctor is a partner. Being attributed to OneCare does not affect your health insurance benefits. OneCare and our health care reform effort has frequented news articles and commentary recently, with not all the information provided being factual. The Green Mountain Care Board website hosts seven legislative one page summaries about Vermont’s health care reform efforts. Those summaries can be found here and the OneCare testimony can be found here (see both Jan 16th and 17th testimony.) I will also continue to use my legislative updates as a fact based communication mechanism for these efforts and to ensure the public that the legislative body is overseeing these efforts. Some of the issues other House committees discussed this week:
Change the Story VT presented to the Women’s Caucus their new report that looks at how Vermont woman experience work and how our systems impact their financial well-being. Just a few of the eye-opening findings:
Finally, the Senate and House reached consensus on the Paid Family and Medical Leave Bill (H.107). This bill passed the Senate on Friday by a vote of 20-9-1. The House expects to take action this week. I’m honored to serve Essex Junction in Montpelier but can’t do it effectively without hearing your hopes and dreams for our community and Vermont. Please reach out at any time – 802-373-0599 or Houghton.lori@gmail.com or through my website's contact section. Thank you, Lori We are back in session and have hit the ground running – an indication that we will have a fast paced session this year. In the Healthcare committee, on which I serve, our most pressing issue this week was hearing testimony from the Brattleboro Retreat and Agency of Human Services. With cash on hand of only 30-40 days and utilization of only 60% (acute care beds are close to 90-95% capacity) - the Brattleboro Retreat asked Agency of Human Services for additional funding or they may need to close, sell or downsize. Just a few days before the session started it was reported that the Secretary of the Agency of Humans Services turned down that request. The Brattleboro Retreat is not only a primary element of our mental health system and is 100% of the State’s capacity for inpatient children’s beds, but is also an economic engine in Windham County. Steps towards a productive collaborative conversation were made last week between the two parties and the legislature will continue to stay abreast of the situation.
We reviewed the administration’s budget adjustments for the departments under our jurisdiction – Department of Vermont Health Access and Department of Mental Health. This is an annual mid-year process that starts in the House. We review the Administration’s budget adjustments recommendations to provide House Appropriations policy feedback. One area that stood out in this review - The Department of Mental Health has ongoing pressure in residential treatment for children. Although many factors cause this pressure, primarily it’s due to an increase in the acuity of clinical need for children. Our committee will continue to work with DMH and other stakeholders on both children and adult needs and the system of mental health. The Vermont’s healthcare system is considered a “merged market”. This means individuals and small businesses are combined into one market for assessing risk and offering plans through Vermont Health Connect. This merged market includes approximately 74,000 people. Act 63 of 2019 required the Agency of Human Services to evaluate the impact of health insurance premiums from fully separating the merged individual and small group markets and to develop a strategy for making health insurance more affordable for all Vermont residents. Stakeholders met over the summer and fall and presented their findings to our committee. What ensured was a lively and thoughtful discussion on several proposals including fully unmerging or partially unmerging the markets. This was the first of what will be many committee discussions this year on Vermont’s health insurance structure. In the first week no bills were voted on, but I expect that to change quickly. Both paid family leave and minimum wage legislation moved to conference committee’s this week. Should the committee’s reach agreement on their respective legislation, both chambers then have an opportunity to vote up or down (the chambers cannot make changes to the legislation). This past weekend in Essex - myself and a small group of planners, along with many, many volunteers with support from area organizations hosted our first annual Gather at The Table dinner. This free event included a delicious dinner, an open gym, music, board games and the opportunity to chat with new and old neighbors. Our intention was to gather our Essex and Westford neighbors, to connect the non-school and school communities and to enjoy an evening together. Well over 400 people attended! We’ve already started our planning for next year. My heart is full! I hope these weekly updates will remain informative. Please reach out with questions and comment to Houghton.lori@gmail.com or 802-373-0599. A bill that received little attention outside of the Statehouse was signed into law today by Governor Scott. H524 originated in the House Healthcare committee after weeks of testimony and thoughtful discussion. It is a broad marketplace stability bill that seeks to protect Vermont's insurance exchange and to protect Vermonters from the dismantling of the affordable care act.
In the health care world, we are often working to balance two opposing schools of thought. One side looks for an expansion of government, and simplification of the existing system by limiting payers. Conversely, another point of view looks to enhance competition, and subject the health care market to a fully free market system. While the visions from each side may be worth pursuing in the long term, it is important for Vermonters to have a functioning and accessible health care system today. This legislation looks to address the pressing concerns of today, while continuing to consider more systemic reforms to how we provide - and pay for - health care in our state. Although this legislation covers many pieces of health care, the most important to me is the consumer protections, that are in the affordable care act, but were not in state statute. If the affordable care act is repealed or dismantled, now, in Vermont we will have the following protections:
In my short 3 years in the legislator, the house healthcare committee has continued to battle against the threats at the federal level to dismantle the affordable care act. H524 is a giant step forward in protecting Vermonters. Yes, we still have a lot of work to do on cost and access. But I will rest a little bit easier tonight knowing we have these protections. Well our goal was to be finished with the 2019 legislative session on May 18th. As we all know sometimes deadlines must be pushed out. Although only the budget and revenue bills must pass prior to adjournment there are still several priority initiatives we are hoping to finalize this week. Below is a recap of the legislative session thus far:
55 bills have been passed by both the House and Senate while 26 of those bills have been enacted into law. Bills enacted into law include (but not limited to):
Bills awaiting the Governor’s action include (but not limited to):
Bills yet to be resolved between House and Senate include (but not limited to):
Fortunately this is year one of the biennium so unresolved bills will carry forth to next year. I’m happy to talk further about any of the bills listed here and those not listed. I can always be reached at lhoughton@leg.state.vt.us or 373-0599. June 1st is the next Essex/Westford community conversation from 8:30am to 10:00am at The Nest Café located on Main St in the Village. The time we spend in Montpelier is productive and important, but so is spending time in the community. I look forward to adjourning this week and seeing everyone around the Village. Please don’t ever hesitate to stop me in the street, at the grocery store or anywhere else – I’m always happy to chat. Thank you for the continued opportunity to serve Essex Junction! Please join us for our next community conversation June 1st from 8:30am to 10:00 am at The Nest located at 17 Main St in the Village. We will provide a wrap up of the session (hopefully!) and answer questions. Come early, come late – stay for 10 minutes, stay for the whole time. Hope to see you there!
As the session winds down the only must pass bill is the budget. The budget always begins in the House, then is sent to the Senate. The Senate passed their budget out of Appropriations Friday with floor action expected this week. Once they pass, the House Appropriations committee will review and either concur with their amendments or recommend that the two bodies meet in a conference committee to hash out the details. Two of the bills we passed last week (there were 6 total) include: S. 40 an act relating to testing and remediation of lead in the drinking water of schools and child care facilities which requires all school and childcare facilities to test for lead in the water. As passed the bill attempts to cover the full costs of any needed remediation and replacement of fixtures with an appropriation of $3.2 million. S.43 an act relating to prohibiting prior authorization requirements for medication-assisted treatment which prohibits a health insurer from requiring prior authorization for a patient receiving MAT and for any counseling and behavioral therapies associated with that treatment. The House Government Operations Committee passed out their version of the bill to tax and regulate marijuana which is quite different from the Senate passed bill. The bill can be found at www.legislature.vermont.gov under House Calendar dated Friday May 3rd. Some of the changes the House made – towns will need to opt in to allow a retail establishment, 30% of tax revenue will be routed to a specific fund for prevention and concentration levels are capped. The bill is now going to House Appropriations and House Ways and Means. No timeline yet on when the bill will make it to the floor. A big thank you to all who helped on GreenUp Day and to all those residents I see picking up trash as they take their walks – without it having to be GreenUp Day. It does take a Village! Please reach out with questions, comments or concerns. Thank you for the continued opportunity to serve Essex Junction. Lori Houghton With the end of the session just a few weeks away, I will focus our attention on three bills working their way through committees to reach the floor for a vote. I appreciate constituent feedback and can be reached at lhoughton@leg.state.vt.us.
S169 an act relating to firearms procedures, otherwise known as the waiting period bill, currently in House Judiciary would require a 24 hour waiting period on hand gun transfers after the completion of the background check. It would not apply to hand gun transfers that do not require a background check. The bill also makes changes to various pieces of the 2018 gun legislation related to large capacity ammunition feeding devices, shooting competitions, reporting on extreme risk protection orders and allows for, does not require, healthcare provider notification options. S23 an act relating to increasing the minimum wage passed out of House General and will now go through the money committees. The bill would raise the minimum wage gradually until it reaches $15 in 2024. Thereafter, the minimum wage would increase each year by the percentage increase in the Consumer Price Index. Unfortunately, no language was added to raise the wages for Medicaid-funded health care workers. Over the past two years we’ve worked on this issue in the health care committee increasing funding for mental health workers, but workers at home health agencies, nursing homes and others have not seen an increase in wages. This is an issue we need to focus on in the near term. S54 an act relating to the regulation of cannabis. Although a vote in the committee has not yet occurred and language is not final, the committee has added language regarding a Substance Misuse Prevention Fund. Thirty percent of the revenues raised by the cannabis excise tax, not to exceed $6 million per fiscal year, would go to the fund for prevention education. No decisions, as of this writing, have been made to roadside testing requirements. Other areas of importance from last week – the House Energy and Technology committee held a public hearing on proposed bills that would ban or limit new fossil-fuel infrastructure (H.51, H.175 and H.214) The hearing was well attended and the committee will continue to work on this issue. The House passed S.86 which will increase the legal age for buying and using cigarettes, electronic cigarettes and other tobacco products from 18 to 21 years of age. Passed originally in the Senate the House concurred with their language except to change the effective date to September 1, 2019. This was the third leg of our strategy to reduce youth tobacco usage. Please reach out with questions and comments! Thank you for the privilege to serve Essex Junction. Lori Houghton Please join us for our next community conversation June 1st from 8:30am to 10:00 am at The Nest located at 17 Main St in the Village. We will provide a wrap up of the session (hopefully!) and answer questions. Come early, come late – stay for 10 minutes, stay for the whole time. Hope to see you there!
A few of the bills we passed last week (there were 6 total) include: H207 an act relating to approving an amendment to the charter of the City of Montpelier regarding non-citizen voting in City elections. This approval, if passed by the Senate, will allow legal non-citizens to vote in city elections. S.49 a bill that regulates PFAS in drinking water and surface waters in Vermont on a vote of 135-1. This bill establishes regulatory monitoring of drinking waters to ensure that Vermonters remain safe and manufacturers are held accountable for their waste. On or before December 1, 2019 all public water systems in Vermont will be required to conduct monitoring for PFAS. S.68 which changes the name of the legal holiday from Columbus Day to Indigenous People’s Day. This week: We will take up on the House floor S.86 which proposes to raise the legal age for buying and using cigarettes, electronic cigarettes and other tobacco products from 18 to 21 years of age. The goal of S.86 is to reduce tobacco use by youth and protect developing brains, uniquely vulnerable to the effects of nicotine and nicotine addiction. The Surgeon General predicts that 10,000 Vermont youth alive today will die prematurely of tobacco-related illnesses if we fail to change course. In the House Health Care Committee we will continue our discussion on a bill to license ambulatory surgical centers in Vermont and hear testimony on electronic medical records. As I’m sure all have heard the Senate passed out a bill to tax and regulate marijuana which is now working its way through the appropriate committees in the House. I welcome feedback on this measure – should it pass? With certain restrictions? With specific prevention or safety measures? Please email me at lhoughton@leg.state.vt.us. Thank you for the continued opportunity to serve Essex Junction. Lori Houghton Please join us for our next community conversation April 13th from 8:30am to 10:00 am at Sweet Alchemy located at 45 Upper Main St. This is a time to talk with your Essex area representatives about issues of importance to you. Come early, come late – stay for 10 minutes, stay for the whole time. Hope to see you there!
Last week the House passed out H107 Paid Family and Medical Leave bill on a vote of 92 – 52. As many may know the United States is one of only two countries that does not offer a paid family medical leave insurance program that is universal. Currently only 15% of Vermonters have access to any kind of family and medical leave insurance and some of those aren’t offered a plan that is substantial enough to take any meaningful time off. This legislation seeks to keep Vermonters here and attract new workers, provides a level playing field for small businesses and protects our most vulnerable Vermonter. In its current form, H107, provides eligible employees up to 12 weeks per year for parental and bonding leave and up to 8 weeks for personal medical and family caregiving leave. Total leave in one year cannot exceed 12 weeks. An eligible employee is one who has earned at least $11,200 in at least 6 months of the last 4 calendar quarters. If someone works multiple jobs, the earnings would be calculated across all employment. The program is paid by employee contributions - employers can cover some or all of the cost. There are many more details I can provide for anyone interested. H107 now moves to the Senate. The Health Care Committee, on which I serve, continues its deep dive into understanding Vermont's ACO system. For those who are not familiar with this system, ACO stands for Accountable Care Organization. In its simplest form, ACO's are organizations of providers, usually centered around a hospital and the surrounding care practices, that agree to be collectively held accountable for the quality of care that patients ("attributed lives") receive. The intention of having ACOs is to give medical providers greater flexibility in providing treatment, and incentivize coordination of care. For example, in this model, primary care physicians are financially rewarded when their patients do not need to use the emergency room. Vermont has a single statewide ACO, called OneCare Vermont. Whereas many ACOs in other states are linked only to Medicare, Vermont's ACO uses the "All Payer Model." This means that all the payers - Medicare, Medicaid, Blue Cross / Blue Shield, MVP - are connected to OneCare. The idea of having an ACO is to gradually switch to a "Per Member Per Month" payment model, where provider networks are given a lump sum of money to keep their patients healthy each month, instead of having to bill for every individual service, which is the current "fee for service" system. The testimony we've received surrounding ACO's has raised a number of questions for our committee to continue to work through, including what oversight the state should have over OneCare Vermont, whether having an ACO will really change the quality of care received, and how the savings from the ACO compares with the administrative cost of the ACO. Thanks for your time in reading the legislative updates. Please don't hesitate to reach out with questions or comments. Thank you for the continued opportunity to serve Essex Junction. Lori Houghton |
