Week 20

Capitol Connection

 

I was struck by how my ride home from the Capitol Friday morning at 1 a.m. was a lot like the last three weeks of the legislative session. Cruising happily but tired listening to some great music, I abruptly met a fireman just outside of Worcester Village in the middle of the road who told me the storm had brought some power lines down and I could not get through. Faced with turning around and heading all the way back to the interstate, I took the short cut over the mountain top along Gould Road. It was one of those turn the radio off moments, both hands tightly gripping the steering wheel, be ready for anything encounters. Those who know me know that I am exceedingly prone to getting lost, and I was sure I would. The end of the session was much the same way, we hit a detour, called “I can save you $26 million”.

Yes, the Governor proposed a plan that became a great sound bite. He advocated for taking negotiation for health insurance away from local school boards and replacing those negotiations with a statewide teacher’s contract for health insurance. He claimed he could save property tax payers $26 million. The allure of saving $26 million was powerful, many jumped quickly on the bandwagon.

I learned a lot a long time ago from a great Vermont leader, Sister Janice Ryan, when she said to me “Dave, no matter how thin the pancake there are always two sides to everything”. So, I started to peel the onion and quickly realized that moving to a statewide health insurance contract would have many unintended consequences.

First, it became clear that if the state negotiated a contract and captured and kept all the savings as the Governor proposed our local schools would have none of the savings. How could they lower taxes? How would they pay for routine cost increases? What if the freezer in the cafeteria had to be replaced, or it was time to get a new school bus, or they had plans to put savings away to help lower the cost of a bond for a new gym, or roof? If they had planned to use some of the savings from lower health insurance contracts that they negotiated to pay for those things they would be out of luck. The state would have spent those savings and the cost increases would have to be passed on to the tax payers.

Second, to achieve the magnitude of $26 million in insurance savings, the contracts would cover not just teachers, but all school employees including hot lunch staff, crossing guards, janitors, everyone. Most teachers across the state pay roughly the same for their insurance, with some variation. Non-teaching staff, other than administrators, receive lower wages and the differences they pay for health insurance are significant. Some only pay 3% of their insurance. Others are eligible for employee only coverage, others have family coverage but pay 40 percent of the cost. To move to a statewide contract where everyone will pay 20 percent of the cost, as the Governor proposed, would be very problematic and in some cases cost more. A one size fits all policy seldom works as intended.

Third, moving negotiations for health insurance from the local level to the state level, puts teachers at an extreme disadvantage. They have nothing to trade, or offer in return for wages. Their leverage would be gone. Some may like that, but it is not fair.

By this point there may be some who say “okay, I understand nothing is completely fair Dave, but we want savings”. To be clear the Governor’s plan never saved much. He spent most of it. His plan spent two-thirds of the money and would have given one-third of the savings in property tax relief. That may sound like a lot of tax relief but in the first year that would amount to less than $7 for a Vermonter in a home worth $200,000. In the second year it would be around $13.  “I can save you $26 million” is a great sound bite, but in the end that is all it is, a sound bite. I too want savings. I just am not convinced this plan will get them.

It would be wrong to think I do not like the Governor, completely wrong. I respect him and so appreciate the civility and the good will he brings to the office of Governor. When I ran for office I heard from more than one person who said,” I want you people to get along”. I think it is healthy to disagree. I insist that we be respectful though, and for that I admire the Governor. I am hopeful in the end we will find a solution that supports tax payers and respects teachers, but most of all helps students succeed.

In closing, instead of doing a wrap up of all the things we did this year, I wanted to highlight two things. I know other media outlets will provide an inventory of the laws enacted and provide a good explanation. I am proud I helped write a budget that increased state spending by just .7 percent without any new taxes or fees and provided significant funds for the mental health crisis we face and targeted relief for infant care at our child care programs. Hats off to our Senator Richard Westman for the work he did to help in this regard. Personally I am proud of the work I did to secure a funding increase for our Home Health agencies across the state. I was able to secure support by finding savings elsewhere in the budget to cover this critical need.

This is my last regular column for this year, I think! I am very thankful to the News and Citizen for letting me report to you on a weekly basis. If I can be helpful, please feel free to email me at David.Yacovone@gmail.com or call me at home at 888-5958. Now I am of off to catch up on the “honey-do” list which has grown quite long.

Week 19

Capitol Connection:

 

I smiled as I listened to a fellow legislator talk about how being a legislator was hard. He lamented about how he had always attempted to help people, to make them happy. Being a legislator he said ultimately puts you in a position where some people are not going to be happy with you. You have to make decisions and not everyone is going to like them.

I sure could relate to what my friend was saying. After weeks of contemplation I had come to the conclusion that legalizing marijuana would be the better thing to do than living with the status quo. I had heard from some people who flat out said to me, “if you vote for marijuana I will never vote for you gain”. Others had called me to say,” If you don’t support marijuana I will never vote for you”. And, others just weighed in without threats, and rendered their opinion.

Interestingly, the research I received on the pros and cons of the marijuana issue were all over the place. Material from physicians would describe in detail how marijuana was a gateway drug leading to worse abuse. Academic articles submitted by others would explain a different outcome. For every opinion or claim, there was another to refute it.

I determined that all I could do would be to listen closely to every opinion, read every message sent to me, and then exercise my judgement, given how passionate many were on both sides of the issue, and the conflicting information.  I finally came to a decision after weeks of contemplation. I scribbled down some comments and went to the State House and thought perhaps depending on how the debate went, I would offer a few words on this issue. After several speeches against legalization the debate seemed very one sided so I figured I would offer my comments. Here is the text of my speech, to help explain to people why in the end I supported legalization of marijuana:

Madam Speaker, let’s assume everything we have heard about the ills of marijuana is correct. Every bit of it. That it is a gateway to worse drugs, that it leads to testicular cancer, it causes crime, and much more.  Assume it is all spot on accurate, despite much information in many instances to the contrary.

 

In my mind, if you want all of those bad things to continue, simply do nothing, leave things as they are.

 

If you want some two hundred million dollars leaving the Vermont economy through the black market every single year, instead of staying to recirculate among Vermonters, hold steady, do nothing.

 

If, on the other hand, you want more prevention efforts, more enforcement efforts where they’re actually needed, more treatment options for people struggling with addiction, choose a different course.

 

I am reminded of the old adage, “if you always do what you have always done, you will always get what you always got”.

 

I do not want what we have always gotten Madam Speaker.

 

I do not want business as usual, I do not want complacency when it comes to the safety of Vermonters.

I do not want the upwards of eighty thousand Vermonters who use marijuana regularly driving on our roads, though I know we cannot legislate that away any more than we can drinking while driving, but I am hopeful we can diminish it.

 

I want a regulated market Madam Speaker where the bad actors who sell this today are replaced with responsible, regulated, locally owned businesses that check ID, label their products, and are subject to inspection.

 

I want stepped up prevention, the same way we have fought mightily for smoking cessation efforts, and made dramatic progress, using cigarette taxes to fund programs that cut the teen smoking rate roughly in half.

 

I want hard working Vermonters to sell this crop and make a return off their land instead of criminals walking away with the cash.

 

If we continue to do nothing, we get none of that. If we legalize we have a chance to make things better.


The eras of Richard Nixon and Nancy Reagan have come and gone. The days of mass incarceration and “Just Say No” have failed us.  As other states and countries move to legalize, it is in our best interest to do the same.

I woke up the next morning to find my picture on the cover of the Burlington Free Press with a “Got Pot” sticker on it. I simply had an opinion I wanted to share, after much soul searching. I did not go to Montpelier to be the poster child for pot.

I had hoped this would be my last article for this session. As of this writing we are hoping to conclude next week, if we can agree on a way to lower property taxes. More on that subject next week.

 

 

 

Week 18

Capitol Connections

It was an exciting week at the State House. The topics ranged from marijuana, family leave, a new Green Mountain Retirement Plan, property taxes and much more.

The major controversy centered around a proposal by the Governor to save an estimated $26 million by having health insurance bargained through a statewide contract instead of at the local level as it is today.

There were two proposals before us relating to the Governor’s plan. They were very different, though they dealt with the same topics; property taxes, health insurance and unions.

The first proposal was the “Beck Amendment”. It would implement a statewide contract for teachers’ health insurance. Assuming the negotiations went accordingly, the estimated savings could be $26 million for a full year. The second alternative amendment, known as the “Webb Amendment” also aimed to save $26 million but left the bargaining of insurance benefits at the local level.

A key difference between the two amendments, besides how health benefits would be negotiated, was what would become of any savings. The Beck amendment would allow the savings to be spent. In fact the Governor, who strongly supported the amendment, called for spending some of the savings on state colleges and child care. Many people never imagined their local property taxes would be spent on colleges, but thought they were for their local schools.  

The teachers union has felt attacked by these discussions. They believe if health care benefits and wages are split, with their school board negotiating with them for their wages, and the state bargaining with them for their health insurance, they are at an extreme disadvantage. Their ability for example, to offer to pay more for their health insurance but receive a larger pay increase would be gone. Instead of bargaining for better pay or benefits they would be left to simply plead for more as their bargaining leverage would be gone. Some have suggested this is why the Beck proposal has been offered, to break the union.

I decided to support the Webb amendment because it guaranteed the savings would go to lower local property taxes. There were many who claimed, including school board members, that the process of bargaining benefits was challenging and that the locals were no match for the high powered union, and it was unlikely large savings could be achieved. Others said that while it was hard work, local boards did a good job. In fact, right in the Lamoille-South district $200,000 in health insurance savings has been achieved through local negotiations.

There were many who were frustrated that the Governor waited until the end of the session to offer his proposal. While his current proposal does not guarantee the savings will lower taxes, he should get credit for trying to keep this issue front and center on the public policy agenda. I am hopeful we can find a workable solution that respects our teachers and helps taxpayers at the same time.

 

Week 17

Capitol Connections – Week 17

At a recent legislative breakfast, a friend asked a $64,000 question. She asked what we were doing about all the reports of raw sewage dumping into our waters across the state.  I cannot speak for the other legislators but I felt like the answer “nothing” might have been close to accurate.

To be clear there is money in our capital budget to help with the Lake Champlain clean-up and other work on the Lake Memphromagog and the Connecticut River basins, but much of that is an after the fact response and in no way proactive work.

Throughout the week the raw sewage question kept haunting me. I began to wonder what else as a state we were being remiss with and did some research. Sadly, after years of neglect we have amassed a huge burden for our children and grandchildren to fix.

The Agency of Transportation has estimated that in order to fix our structurally deficient bridges we need to spend $100 million every year for the next twenty years.

There are roughly 1200 dams in Vermont and 198 have been classified as having a significant hazard potential. The cost to remove those that need it is estimated at $22 million and those needing repair will cost $35 million.

Vermont has nearly 1400 public water systems, most being small community organizations. The cost to keep these systems from falling into disrepair is a staggering $510 million over the next 20 years.

Waste water needs are staggering too. We have 7000 miles of rivers and streams and over 800 lakes and ponds we need to keep clean. The estimate to keep our wastewater and storm water sewer repairs and retrofits current is $150 million annually. The American Society of Civil Engineers scores states on the quality of their Infrastructure. Vermont’s wastewater system scored a “D” on their most recent report.

The list of infrastructure need goes on and on. Solid waste disposal, roads, school replacements all come at a cost.

It is easy to cite problems with no solutions. The problems we face are not those created by any one Governor or legislature, but come from decades of indifference.  It seems we all live in the moment. It could be our one-year budgeting cycle adds to this short sighted view.

Our failure to keep current on our obligations is not just limited to the bricks and sticks of government.   Our state pensions for teachers and state employees are under funded by some $1.8 billion that we are projected to pay retirees over their lifetime. We will pay roughly $70 million next year alone to catch up on these back payments.

In the same way we pay millions of dollars to try to catch up for the years we did not fund our retirement liabilities for teachers and state workers, we now need a similar commitment to help make sure Vermont’s infrastructure does not fall apart.

 The old adage of “pay me now or pay me later” comes to mind. Seems we have chosen to pay the bills later. In truth however it will not be us who pay later. Our children and their children will be saddled with these debts. As the line from Apollo 13 said, “Houston we have a problem”.

 

 

 

 

 

Week 16

Capitol Connections

 

“If our beds are filled, it means we’ve failed”. I heard this quote from Mount Sinai Hospital during testimony on health care payment reform and thought how in a few words, it spoke volumes.

Imagine providing a service and instead of being paid to serve people, you were paid for not seeing them. Sounds odd, but this in part is the cornerstone of how Vermont, and other states some more than others, are building a future system to help achieve affordable health care.

At the risk of over simplifying, assume on average today you are paid $5,000 for every inpatient admission, and on average you admit 15 patients a day. Payment reform for tomorrow might say we will pay you for your historic average, 15 patients, and if you admit only 12 patients you will still be paid as though you had admitted 15. But, if on average you see 20 patients, the risk is on you, you will only be paid for 15. All of a sudden your top priority is to keep people healthy and out of the hospital. Sounds easy, but of course nothing in health care is. Risk corridors, risk adjustment and reinsurance may be technical terms but they are very real for providers looking for protections.

The organizations that are attempting to manage this payment transformation are called Accountable Care Organizations, otherwise known as ACOs. Some, cynical over past efforts to reform health care, who wanted a single payor system are reminded of Health Maintenance Organizations, HMOs, and see ACOs as more of the same; bloated bureaucratic entities focused more on providers and profits than on people. To guard against poor outcomes, the health care payors, Medicare, Medicaid and commercial insurance companies, are designing quality report cards to measure the performance of ACOs and tying their payments to outcomes. All of this is an experiment that the federal government has encouraged as a way to rein in costs.

The stakes are high. If we do not succeed in controlling health care spending, we continue to drain Vermonters by choking them with uncontrollable premiums, co-pays and deductibles. If these efforts are not designed and implemented properly we could destroy our hospitals. We will have to support them if they cannot manage care and they start to go under.

Hospitals and physicians will likely complain that they should not suffer financially for the poor behaviors of many of the citizens they serve. A person, stuck on the couch with a remote control in one hand a beer in the other, feeding on a diet of Twinkies with cigarettes for dessert is a liability not only to themselves, but under these payment changes, to the health care system too. This is not meant to be insensitive. Instead of criticizing many for behaviors we might find offensive, our system now has an economic incentive to help address the underlying addictions and stresses driving these behaviors. None of this means to absolve any of us from personal responsibility, but slogans like, “move more and eat less” may not get at the underlying reasons for dangerous behaviors. But I digress.

 

As the movie title said, “It’s complicated”.

You might be wondering why I would elaborate on this issue as the legislature is winding down for this year. We are trying to focus on next year. This area of our economy, much the same as the property tax, is perhaps the biggest challenge to living affordably in Vermont. The issue is wrought with politics and policy, not uncommon when money, a lot of it, is involved. There is no way in a 600 or so word column I can cover all of the aspects of this topic. But I do want to say that as a citizen legislature we have to play a role in these policy changes. Consumers need protection, and providers need to be treated fairly. I do not think it would be acting responsively to leave all this solely to the experts. The public needs a voice at the table.

 

 

Week 15

Capitol Connection – Week 15

 

At the beginning of the legislative session a friend sent me an article about the importance of listening to others, especially when you disagreed with them. When I first received the article I was inclined to dismiss it, thinking to myself that I always listen to people, then I read it, slowly. The article stuck with me, I printed a copy and brought it to Montpelier and put it in my desk thinking there may come a time when I would need to refer to it. That time came this past week.

Debate was going for what felt like forever over a workers compensation bill. Some of those with opposing views struck me as insensitive, with holier than thou attitudes. Then I caught myself and realized that just because the delivery of the message I was hearing was not appealing there still might be substance to it. I recalled the article in my desk and pulled it out.

I was reminded to breathe, relax, listen deeply, not just to hear the words or get lost by the anger of the other person, but to concentrate intensely on what they were trying to say, to learn from what they had to offer. The seats in the State House are not the most comfortable, the acoustics are not great, but I challenged myself to listen respectfully to the opposing views.

I began to hear the message of those in the minority. It was not that they were insensitive to the plight of the mentally ill, though sometimes their words might make you think so. Their message was the fear of the unknown. What would it cost to provide workers compensation to those who acquired post-traumatic stress from their job? Policemen, ambulance drivers, emergency workers, first responders and many others often endure unspeakable traumatic moments, some repeatedly and it can impact them greatly. The bill we were debating was intending to help them. Some were against it because the full cost was not clear; others were for it because to do nothing for those with mental injuries is costly too. Broken families, damaged marriages, traumatized children and addictions caused by untreated job related trauma carries a high price tag too.  Both views had merit; in the end I voted for the bill.

I had another incident where I was thankful for my friend’s advice to listen deeply to opposing views despite the confrontational styles. A fellow legislator was not amused or swayed when I recalled the words of my mother and said to him, “if you point your finger at someone remember your other fingers are pointing back at you.” This legislator did not take kindly to my suggestion that perhaps we could take some of the state spending we give to the University of Vermont and transfer it to the Vermont State Colleges.  He exploded with emotion, it was as if I had criticized a family member. His point, made while he was hollering at me, was that I was oblivious to what an amazing asset UVM is to Vermont.   I argued back that the value of UVM to Vermont was not the question. The question was whether UVM should get over $42 million a year in tax dollars to educate roughly 4000 Vermont students while the state colleges get $24 million to teach over 10,000 Vermont students. Wagging his finger in my face he said I was comparing apples to oranges because we support not just students at UVM with our appropriation but also the medical school and the extension service.

Neither of us changed our position, he a UVM alumnus and I a Johnson State College graduate. But, I did reflect long on what he said after I decided to let the dust from our confrontation settle. We decided it best to reach out to a neutral party to independently analyze our spending for these two fine institutions to determine if there is a real disparity and inequity as to who is or is not getting their fair share in state funds. So, in a sense though we had a disagreement, we found some common ground.  

The point to all of this to me as I try to represent people in Montpelier is to listen deeply and respectfully to all, regardless of their position or hostile style; they could be right!

Week 14

Capitol Connections

 

The ink was barely dry on the House budget proposal for next year when we quickly started working on the following year. While the Senate deliberates on the proper amount of spending for next year, the House Appropriations Committee has already started to take testimony in preparation for fiscal year 2019.

It is clear to me that we cannot sustain the level of services we have in Vermont unless we rethink how we do business. There will be some who insist that we raise taxes, especially on the wealthiest among us to meet the needs of Vermonters. I do not embrace this approach. Why? I am not unwilling to raise more revenues from those who can afford it, but to do so now is very premature. We need to wait and see what impact the Trump budget will have on Vermont, and save whatever revenue raising capacity we may have until we know the extent of the problem.

In the meantime, I am advocating that we try to reengineer the delivery of services to Vermonters, not just to balance our budgets in the short term, but to fund from those savings investments that will save us money in the long term.

Vermont unlike many other states does not have a county government that provides a broad spectrum of services that extend beyond law enforcement. Many of the roughly 3100 counties across America provide housing, health care and social services. Vermont relies on a vast network of nonprofit organizations to provide state funded services.

Over the years a form of human services sprawl has developed. Each organization has an administrative overhead structure that has to be supported, before funds are provided for direct services. What if we could consolidate the administration of these organizations? Could we save money? What if instead of each organization having a business office manager and staff that paid bills, did payroll, accounted for revenues, managed insurances and such, there was one, or several regional business offices if needed, that performed those duties instead of many?

Years ago then Vermont Mental Health Commissioner Rod Copeland brought some 15 mental health organizations together and told them he had to cut their budget. He told them he would far rather reduce their administrative costs than cut back on direct treatment services. He asked them to come together with ideas to consolidate management functions across the agencies. His request was not met with great enthusiasm. Five of the small agencies did however join together and helped form an organization that could perform administrative functions less costly than they could do on their own. Today the administrative costs of those agencies is less than that of their peers.

Over the years I have suggested to other organizations in Vermont that they too should rethink how they provide these back room management services by consolidating these functions. I recall vividly what it felt like to be a skunk at a party.

What if our five Community Action Agencies in Vermont joined together and partnered to save money on administrative costs? Could our five Area Agencies on Aging do the same? How about our twelve mental health agencies, and our fifteen Parent Child Centers, could they too reengineer their business office functions, quality assurance or other management tasks? My guess is, human nature being what it is, the efforts would not move fast or get far.

The State of Vermont that pays these organizations needs to lead the analysis of such an effort. To expect people who could likely lose their job to lead the analysis is not realistic. But the State who contracts with these organizations to provide services to Vermonters could do an objective analysis and then decide to grant funds to those entities with lower administrative costs. Some of the savings that might be generated could be shared with the agencies to do more direct service work, or pay their staff better, and some could help balance the budget.

We need to reimagine how we serve Vermonters. Instead of a system that sends families seeking parenting assistance to one organization, then to another agency for food assistance and yet another for help with housing, could we integrate these services and do it at lessor costs while serving families better in a holistic fashion? Could we combine these services with our other health care providers?

We cannot continue business as usual. I am not suggesting that we make these types of changes without careful analysis, but I am saying they are way over due for discussion. And to be clear, just focusing on administrative efficiencies that might be achieved is only half the story. We need to help our various community organizations come together to focus strategically on adverse childhood experiences, which research shows can be a powerful predictor of poor health throughout life. But that will be the topic of another article.

 

Week 13

Capitol Connection – Week 13

 

Over eleven of the past twelve weeks I have been in a small committee room with ten other legislators working on the state budget. It is a small room roughly 20 by 20 feet, usually jammed wall to wall with witnesses and television cameras watching our deliberations with baited breath. Many would worry whether we would cut their budgets as we worked to close a $70-million-dollar budget shortfall. As you may have heard from the statewide media we managed to balance the budget without new taxes or fees.

As our work winded down I started to focus on another cause I have been drawn to beyond balancing the budget while protecting the vulnerable. I can best describe that cause in three words, the Vermont Way.

Several years ago a law was enacted that mandated school governance models for school districts across Vermont by requiring them to unite with each other in hopes of achieving savings and efficiencies in the name of consolidation. This law is known as Act 46 and to me is a threat to what I refer to as the Vermont Way. My fear is that while the law says it is not the intent of the state to close small schools, that is the logical result of many merger efforts.

Imagine you are in a small town with a five member locally elected school board. You merge with multiple districts and now have one board member who is part of an eleven-member district board.  Several years into the relationship a discussion regarding closing a school starts to unfold as a way to meet a declining student census. Do you think your one member on the eleven-member board will have an adequate voice in the discussion?

Imagine you are required to join a district and several of the towns in the newly formed district have borrowed money. That debt will now be born proportionally by the taxpayers in the other towns who previously had no debt payment in their budgets. Conceivably, citizens from a smaller less wealthy community that could not afford debt  may have to help pay the debt of a town with more wealth. You can see why these discussions can be divisive.

Who would willingly want to enter into such relationship, unless there were some other unique benefits? It is for reasons like this that some 96 towns across Vermont are struggling to comply with Act 46. To be clear many towns have come together to form new workable districts. Others, separated by mountains, or simply without a natural flow between their citizens have struggled. They really never have been connected and to require them to come together now is asking for an awkward alliance.

We need to stop the divisiveness of this law and recognize a one size fits all strategy will not work. We need to strengthen opportunities for alternative governing structures that allow school districts to come together in different ways that may achieve savings or better educational opportunities for children, without giving up all of their local control.

I am not against saving money by partnering with others. I do worry that the closures of small schools that may result, done in the name of saving money, will really produce little savings. Tuition for the children moving to a new school will not come cheaply. The cost to transport children to another school in the district will be more dollars diverted from teaching. I would rather see more efforts spent on combining health care contracts to yield what might be a better return.

Legislators come together from across Vermont to Montpelier to do the work of the people. They sit side by side, shoulder to shoulder, not as Democrats or Republicans, not as Independents or Progressives. They come together united by their love for our little state.  I hope they will band together to help change Act 46 to preserve our small schools and in so doing help preserve the Vermont Way.

Our small schools are the heartbeat of their community. They are the life blood that feeds the spirit of our towns. Community togetherness is a powerful thing. Without it we are little more than isolated inhabitants, wayward strangers disconnected and disenfranchised from each other. Yes, there is a cost to being small. There is an expense to losing our identity too. I look forward to debating this issue in the weeks ahead as many from small towns across Vermont stand to fight for the Vermont Way.

 

 

 

 

Week 12

Capitol Connections

 

What do Veterans, specifically those at the Vermont Veterans Home and Vermonters with Alzheimer’s, especially those seeking help to get into a care setting, have to do with each other? In a word, plenty, but before I explain how let me help set the stage briefly for this topic.

Every day when legislators arrive in the coat room at the State House and check their mail boxes they are flooded with invitations and announcements from various groups to join them for coffee, treats or just conversations that they are sponsoring in the State House or around Montpelier. The range of invitations is huge running from the Chamber of Commerce, dentists, optometrists, anti-hunger groups, ambulance drivers, veterinarians, contractors, you get the picture. The list is endless. You could spend your day drinking free coffee and eating donuts, or an assortment of appetizers, which while I do enjoy the coffee I fight the treats, sometimes unsuccessfully, but I digress.

So, recently in my mail box, which I usually rifle through and recycle, I was caught short by an invitation to join some Vermonters to recognize Alzheimer Advocacy Day. I held the note for some time and thought hard about those over the years I have known first hand as a friend and as a former Nursing Home Administrator for 16 years who have struggled and succumbed to this horrible disease. I thought of the heavy toll extracted from their family members. I asked myself what I could do. Surely Vermont will not find a cure, other scientists may on the national level, but what could I do to help even in a small way for those who live the Alzheimer’s journey.

Later that week I recalled that the Vermont Veterans Home was caught in a financial pickle because many of their patients with dementia related illness scored low on the payment system used to compensate nursing homes. There are over 40 different payment classes that a patient may be categorized into which in turn results in a score, which when averaged together translates into to a daily payment rate for each nursing home.

When the payment system was designed by the Research Triangle Institute in the 1980’s they never accurately considered behavioral needs, but used a patient’s capacity to do what we call activities of daily living to drive the reimbursement. A patient who could not bathe, dress, feed or toilet themselves scored many points. A patient who wandered about fretting, unintentionally disturbing other residents and requiring much time to help settle and comfort, scored very low.

To help remedy this situation and help a growing number of older Vermonters with extreme behavioral challenges who are ending up in our hospitals inappropriately, the House Appropriations Committee has included in the budget bill a requirement that the State of Vermont will adjust the patient payment system to properly score the time and cost necessary to serve patients with dementia who still can do their physical care with moderate assistance. This change will encourage Nursing Homes to admit more patients with Alzheimer’s or psychiatric needs.

Now, back to the Veteran’s Home. Our hope is that by paying the Veterans Home properly for dementia patients it will increase their Medicaid payment rates. Today, the cost to cover the care at the Veterans Home to make up for the outdated payment system falls solely on the backs of Vermonters in the amount of $6 million per year. When we increase the Medicaid payments, the federal government and not solely Vermont taxpayers, will help share the cost. The savings from this change can free up the state dollars to help pay all nursing homes a better rate for dementia related care. This will help families who have a loved one with Alzheimer’s access the security of a 24 hour a day setting when necessary.  

Admittedly this is no way helps a family reconcile why they and their loved one has to endure this disease. It will not change the fact that Alzheimer’s is the 5th leading cause of death in Vermont. Their troubles and pain will sadly go on. But, it will help a segment of the 12,000 Vermonters with Alzheimer’s do better than they are today. I sure wish there was more that I could do.

 

Week 11

Capitol Connect – Week # 11

As I was moving through the State House last week from meeting to meeting, I could not get the words of WCAX Weatherman Gary Sadowsky out of my head. When there is a big storm Gary often says, “It’s rain’n in Canaan and pour’n in Warren”. Well, we had a policy hailstorm raining on us last week in Montpelier.

First came the news that the proposed Trump budget would eliminate the fuel heating assistance program next year, causing roughly 21,000 Vermont households to lose $18 million in financial help to pay their heating bills. Today, 364 households in Elmore, Morristown, Woodbury and Worcester, the towns in the Lamoille-Washington District, rely on this assistance to heat their home.

That news was followed by word that the Community Development Block Grant that helps fund village improvements throughout the state will be eliminated.  Lamoille County alone has received $7.6 million over the years, including $600,000 to help make affordable housing available in the Arthur’s Building in Morrisville.

On top of that we learned that Community Action, one of the mainstays of the social safety net would be zeroed out of the budget, as would Vermont Legal Aid.  Much of the anticipated funding to help us clean up Lake Champlain would be gone too. This budget proposal could be the largest transfer in wealth from the poor to the rich in our lifetime as even more tax breaks for the wealthy are proposed.

If all of that was not enough we continue to hear that the “Repeal and Replace” Trump/Ryan health care plan will cost Vermont a staggering $200,000 million in lost funds to help pay for insurance coverage for thousands of Vermonters. And finally, was the reminder that we have a $3.2 billion unfunded retirement liability for teachers and state employees that needs funding in the future.

A friend of mine suggested filling all of these budget needs with taxes from Vermont would be like trying to fill the Grand Canyon with a spoon. Legislative leaders are suggesting we should keep our calendars open so we can possibly reconvene in November after the federal budget is finalized to determine what we can and should do. There will be those who rally around tax increases to solve the problem. Others will see this as an opportunity to downsize government.  I think I will heed the advice of my late mother who used to tell me “All things in moderation”.