Tag Archives: House Ways and Means Committee

Is there going to be a health care bill? Like, at all?

The clock is ticking on the 2015 legislative session. We’re less than a month away from the usual adjournment, and a passel of “big bills” is just now crossing from the House to the Senate. These include the tax and budget bills, school reform legislation, the water cleanup bill, and the RESET  renewable energy package.

Conspicuous by its absence from this roll call of heavy lifting: the health care bill. It’s been dramatically downsized, and is still being batted around among three House committees. This week, the Ways and Means Committee barely managed to achieve a majority on a financing package after a lot of hand-wringing and internal disagreement. The Health Care Committee produced a scaled-down version of reforms costing about $20 million per year. But the Appropriations Committee, which has to approve the reform spending, has yet to weigh in. Approps chair Mitzi Johnson says her panel will hear testimony on the bill next week.

If that committee takes any route besides endorsement of Health Care’s bill, there may be a fresh round of back-and-forth between those two panels, just as there was between Health Care and Ways and Means on the revenue package.

And then, sometime next week at the absolute soonest, the health care bill will make its way, bloodied, bruised and limping, to the House floor.

If not “the absolute soonest”? We’re getting awfully close to mid-April.

Frankly, it’d take an uncommon outbreak of consensus in the House and between House and Senate for a health care bill of any kind to achieve passage in this session.

There’s a flood-stage ice jam of legislation forming in the Senate. This morning I watched one committee chair working with his staffer to find time to accommodate long and growing lists of potential witnesses. Can we assemble early some days? Can we schedule Monday meetings, an unusual and undesirable step, especially for lawmakers from distant parts of the state? The thought in my mind was, how can they possibly get all this done?

Breaking that jam and moving major bills will depend on the Senate running uncharacteristically smoothly, with unusually effective leadership (cough*John Campbell*cough) and widespread voluntary ego-suppression in Vermont’s Most Self-Important Deliberative Body.

The health care bill, if it gets to the Senate in some form, will take its place in line behind the other Big Bills. Most importantly, it will be the last of the big revenue bills to hit the Senate, and who knows how much appetite they have for tax increases. There’s a significant cohort of moderate-to-conservative Senate Democrats that can diminish or kill any tax measures, and they may be out for blood after pretty much having to approve new money for Lake Champlain and to fill part of the budget gap.

From what I’ve heard, the Senate’s outlook is even more of a mystery this year than usual, and that’s saying something. Big picture, the odds appear to be against any meaningful health care reform getting through the legislature this year.

Which would be a bad thing in three important ways:

— The bill would reduce the sinfully large Medicaid gap. The Shumlin plan would substantially reduce it; the House Health Care plan would make a series dent, at least for primary care providers.

— The bill, in either form, includes more money for proven cost-saving strategies in Blueprint for Health and the Green Mountain Care Board. Continuing to bend the cost curve is crucial to the long-term success of the reform project.

— And third, for those who insist on the humanitarian angle, is that either bill would ease access for thousands of working poor Vermonters.

Lawmakers and legislative leadership know all this. If they didn’t, the bill wouldn’t have gotten as far as it has in a difficult year. Improving health care is a serious priority — but so are a lot of other things. It’d be a shame if health care fell victim to the legislature’s time crunch, but it wouldn’t exactly be a surprise.

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Look out, here comes the Bee Pollen Brigade

Here’s the topline for today’s developments re: funding for improvements to Vermont’s health care system:

$20 million.

That’s the target figure for new revenue agreed upon by key House leaders. A big comedown from the House Health Care Committee’s $52 million, but enough to make some progress in closing the Medicaid gap*, enhancing access for the working poor, and trying to attract more primary care providers.

*The gap closure is likely to favor primary care doctors, since they’re the front line of health care and also the most financially precarious.

Exactly how the House will get to $20 million is unclear. House Ways and Means is aiming to pass a bill this week*, but it would then face an uncertain fate in the Appropriations Committee. And the House floor. And the Senate.

*Committee vote today postponed due to the absences of two Democratic members.

But $20 million seems etched in stone, at least in the House. So this morning, Ways and Means examined five different tax packages that would raise roughly $20 million per year. The options include: some sort of tax on sugar-sweetened AND diet beverages, removing the sales tax exemptions on candy, sweetened beverages, imposing the rooms and meals tax on vending machiens, increasing taxes on cigarettes and/or tobacco products, and my fave: imposing the sales tax on dietary supplements.

Gasp! Yes, lawmakers might force us to pay sales tax on cranberry extract pills, antioxidants, probiotics, pro-oxidants (is that a thing?), and all those other sundry preparations clogging the shelves of your local food co-op.

I am now counting down to the arrival of the Bee Pollen Brigade with cries of outrage. This could be the next mass invasion of the Statehouse.

But it’s among the least unpalatable options before Ways and Means. As of this writing, there’s no sense of a committee consensus or even a majority behind any of the five tax packages. (Conservative Democrat Jim Condon tried a Hail Mary pass this morning; he floated the idea of selling bonds to pay for some health care reforms. The idea was quickly shot down by the Treasurer’s office, which pointed out that it’s considered improvident to bond for short-term spending. Or, to put it in Treasurer’s terms, “You should make sure the useful life of the asset is at least as long as the life of the bond.”)

Ways and Means is working from five proposed tax packages; all five are outlined, with revenue estimates, on the committee’s website.

So, the details of the revenue package remain unclear, but the bottom line is not.

$20 million for health care.

Glass half full, glass half empty

There are two ways of looking at the 2015 legislative session so far. Well, two if you’re on the left-of-center side of the political equation. The right, I suppose, is probably in full Ted Cruz “The World Is On Fire” mode.

You can look at it like Progressive Rep. Chris Pearson during last week’s House budget debate, lamenting big cuts to human services: “There have been program cuts every year since I joined the legislature in 2006.”

The glass is half empty. If you’re a liberal or progressive Vermonter, it seems like we’ve been in constant retreat since Peter Shumlin took office. And it got worse after the November election, with conventional wisdom telling us that Republican gains were due to Democratic overreach, the governor abandoning single-payer health care, and Democrats scurrying to the center.

Then there’s the glass-half-full approach. House Ways and Means Committee chair Janet Ancel noted that this year’s tax bill represented the biggest one-year revenue increase in all her years on the committee. And Health Care Committee chair BIll Lippert had this phlegmatic reaction to the rapid diminution of the health care reform bill:

We knew when we put that together it was robust. That was our job, to articulate priorities and how to get there. But I think in the context of the $35 million that was raised on the floor [in the tax bill], and $8 million for the lake [Champlain], if we were so fortunate as to have $20 million for health care, that’s a pretty big appetite for raising revenue in one year. So I would be pleased to have that much dedicated to health care in a year that’s as financially difficult as this.

And, the unspoken corollary: “I won’t be surprised if we get less than $20 million.”

Which leads back to my previous post, “Peter Shumlin: Defender of Liberalism.” If the House is stripping most or all the funding from health care initiatives, we’ll have to depend on the Governor’s political muscle — if he still has any — to get it back.

Anyway, which way do you see it: glass half full or glass half empty?

The current situation has echoes throughout the five-plus-year tenure of Gov. Shumlin. He’s delivered some good stuff, more than many liberals are willing to admit, while keeping the ship afloat in tough budgetary times. Plus, he’s been swimming against three powerful tides: a sluggish recovery which has yet to benefit the middle or working classes, a tax system that has failed to keep up with our changing economy, and the effort to fully fund public-sector pension plans that were revenue-starved by previous administrations. (Lookin’ at you, Tom Pelham.)

On the other hand, many of Shumlin’s promises have been curtailed or abandoned — most notably single payer health care, the issue that arguably won him the 2010 Democratic primary and hence the governorship. Plus, liberal expectations were inflated, fairly or not, possibly both, by the size of the Democratic majority. Shumlin and legislative Democrats never seemed to realize how much political capital they had; and now, much of it is gone, unspent.

And on the other other hand, it’s not as if the last five years have been without accomplishment. And it’s not as if this legislative session will be a failure if we don’t get significant movement on health care reform.

It’ll just kinda feel like one.

Peter Shumlin, Defender of Liberalism

So this is what we’ve come down to: as the House continues to slash away at health care reform, Governor Shumlin has become its stoutest defender.

Isn’t it ironic, don’tcha think. A little sad, too.

Here’s the situation: the House Health Care Committee originally came up with a $52 million package that would have greatly reduced the Medicaid gap, made health care more accessible to our growing cohort of working poor*, expanded proven measures to enhance delivery while holding down costs, and boosted incentives for badly-needed primary care providers.

*Thanks to our top-heavy economic recovery, which has produced stagnant wages and lots of jobs with unlivable wages while fattening the pockets of the wealthy and corporate.  

The Ways and Means Committee couldn’t agree on any tax scheme to pay for the $52 million — or even part of it. So the ball got bounced back to Health Care with a new diktat: devise a bill that will only cost $20 million a year.

The two committees remain at loggerheads, with each other and within their own ranks. Health Care can’t decide how to downsize its deftly-woven tapestry without the whole thing unraveling, and Ways and Means can’t reach consensus on a tax plan to produce $20 million.

Which almost certainly means the package will be further reduced before it even gets to the full House.

This is where Peter Shumlin, Defender of Liberalism comes in.

“I think that it’s really important that we make real progress here, and you’re not going to make real progress with $10 or $20 million,” the governor said in an interview Friday.

That interview was with the Vermont Press Bureau’s Neal Goswami, who wrote a front-page story in today’s Times Argus about the developing tussle between cautious lawmakers and a determined governor. (The story is paywalled, but you can listen to the interview for free.)

Shumlin rightly points out that a modest health care package would leave “$100 million of federal [matching] money on the table,” and would reduce private insurance rates by closing the Medicaid gap. Penny wise and pound foolish, you might say.

Problem is, the legislature is in penny-pinching mode after approving a tax bill that will raise $33 million in new revenue. Well, that’s the next problem. The first problem is Ways and Means, which has just enough centrist votes to effectively roadblock any of the tax plans outlined by Shumlin or the Health Care Committee.

Hmmm. And who, pray tell, appointed the committee? Oh yeah: Mr. Speaker.

Ways and Means has eleven members. A bill needs at least six votes to pass. But wait, you might be saying, there are seven Democrats on the committee and only three Republicans.

Well yeah, but two of the Democrats are definitely in the party’s centrist wing. Jim Condon is one of the most conservative Dems in the legislature, and Sam Young is definitely a taxation skeptic. The lone independent, ski resort mogul Adam Greshin, might as well be a Republican.

That leaves five relatively liberal votes, and a tough task for committee chair Janet Ancel to find a majority for any tax proposal.

Problem is, the Governor is right: spending more up front would make the system more robust and effective, and bring down costs for private payers. It’d also bring in the aforementioned truckload of federal matching funds.

And oh yes, if you’re interested in the “humanity” angle, it’d make health care accessible to thousands more Vermonters.

Goswami reports that Shumlin “may have to turn his attention to the Senate if he is to rescue his own plans.”

Oh boy. The disorganized, testosterone-and-ego-fueled Senate, with the centrist Cerebus of John Campbell, Dick Mazza and Phil Scott guarding the portal.

Good luck with that, Governor.

.House Health Care gets the brown plate special

Recently, the House Health Care Committee passed a health care bill that raised $52 million in new revenue to pay for an array of reforms, including better Medicaid reimbursement for providers and more premium support for the working poor. It proposed raising the revenue through a payroll tax and a sugar-sweetened beverage tax.

Then it went to the Ways and Means Committee, which couldn’t agree on either tax. Technically they have yet to agree, but they did send guidance to the Health Care Committee that it should craft a plan requiring no more than $20 million a year. Ways and Means is reportedly moving toward a smaller version of the beverage tax to raise that money, although nothing is final.

Well, as one of my childhood heroes, Detroit Lions great Joe Schmidt, says, “Life is a shit sandwich, and every day you take another bite.” When the Health Care Committee reconvened this morning with that guidance in mind, they looked like they’d been served the Brown Plate Special. Glum faces all around. As committee chair BIll Lippert said, tongue slightly in cheek, “We can’t do all that we have to do.”

Committee members had no clear idea how to proceed. There were widely varying ideas. Anytime a specific cut of any size was suggested, sound and reasonable objections were voiced.

When they looked at the overall picture, some members wanted to make big cuts here and hold harmless there; but they all had different heres and theres.

At the end of a necessarily brief discussion (before the House convened for the day), Lippert thanked everyone for their input and said he would try to put together a proposal for futther discussion. And he noted that the committee would need to adopt some kind of bill by the end of the day tomorrow. He didn’t sound very happy.

Whatever Health Care comes up with, it’s likely to face the ax down the road. It’s still unclear whether Ways and Means can pass the reduced beverage tax, to say nothing of its fate in the full House and Senate. If I were a betting man, I’d say any new health care initiatives are going to be whittled down to nothing, or nearly so.

Our Leaders will plead fiscal responsibility in tough times, and perhaps start looking for a bone to throw to disaffected liberals.

House Ways and Means at impasse

This afternoon, the House Ways and Means Committee was scheduled to discuss the health care bill. You know, the one with the two-tax solution: the .3% payroll tax and the sugar-sweetened beverage tax.

Well, it didn’t happen.

The committee took testimony in the morning. But after lunch, members did not reassemble. At one point, committee chair Janet Ancel entered the Ways and Means room; I asked her what the plan was.

I don’t have her exact words, but here’s the gist. They’d heard from all the witnesses, but the committee had stalled out on the two tax provisions. Neither tax would get majority support in the committee, if she held votes today. So, no votes.

No witnesses left. (She jokingly asked me if I’d like to testify.) And apparently she feels that more discussion or debate wouldn’t change any minds.

Welp, without those two tax provisions, there’ll hardly be any money for closing the Medicaid gap or any of the other improvements adopted by the House Health Care Committee.

Ancel had no idea what would happen next, or when it might happen.

Of course, either tax (or both) could be added back at a later point. But if Ways and Means can’t agree on a funding mechanism, it’s  certainly a discouraging sign for those of us hoping to redeem a few scraps of the lost promise of single payer health care.

Big Beverage’s Hired Guns pt. 2: Mountain Dew wishes and Twinkie dreams

“When you work in this building long enough, you notice things like thread count.”              — Anonymous Statehouse scribe

The House Ways and Means Committee heard a full morning’s worth of testimony today on the proposed sugar-sweetened beverage tax. The most interesting witness, not in a good way, was one Kevin Dietly of Massachusetts-based Northbridge Environmental Management Consultants, speaking on behalf of the beverage industry. He definitely had the fineest suit in the room, not to mention bright pearly-white teeth. (Oh, and a Google search indicates that he’s a member of the Chautauqua Yacht Club. Must be nice.)

And he acknowledged, in answer to a question from the committee, that he has represented the food and beverage industries since 1986.

That’s a long time serving the same paymasters.

Dietly managed to actually travel to Montpelier, unlike his fellow soulless industry flack Lisa Katic, discussed previously. I don’t imagine it was a sacrifice for ol’ Kev, since he presumably drew full expenses and a fat hourly rate for his visit to Montpelier. (He stuck around for the full morning, billable to “Stop The Vermont Beverage Tax.”)

(This wasn’t his first trip to the Statehouse; in 2013 he testified for the beverage industry against a proposed expansion of Vermont’s Bottle Bill. Surprise, surprise.)

His testimony was a carefully-crafted web of industry-friendly statistics and studies, plus back-handed dismissals of the academic experts who’d preceded him in the witness chair. You know, the economists, doctors, public health experts and nutritionists who have consistently found that…

— Sugar-sweetened beverages are a scourge of the American diet, leading to high rates of obesity, diabetes, and other severe illnesses.

— Taxing a specific commodity invariably leads to lower consumption.

— Lowering consumption of sugary drinks will have a beneficial impact on public health and public-sector healthcare spending.

— There’s no evidence of a significant “border effect”; in fact, there’s quite a bit of evidence that any “border effect” would be minimal or nonexistent.

— The impact on employment is neutral to mildly positive. Consumption of sugary drinks goes down, but people buy other stuff instead.  The equation balances out. Plus, the tax revenue funds jobs in government or the healthcare sector.

Pish-tosh, said Dietly, slamming “academics” who live in “a different world,” a “theoretical world.” When they retreat to their “ivory towers, things get a little wacky.”

Welp, so much for scientific research. Can’t trust anything they say.

As for Mr. Dietly, when you Google his name you get a massive quantity of testimony before various legislative bodies around the country on behalf of the food and beverage industries. Here’s a sampling of The Expensive Wisdom of Kevin Dietly:

He spoke to a New York Senate committee in 2010 in opposition to a proposed beverage tax. His arguments were essentially the same, then and now: a beverage tax would have disastrous economic consequences (but he entirely leaves out the fact that consumers will substitute other items for taxed beverages, thus mitigating the dreaded financial and employment impact), and it wouldn’t have any effect on public health (carefully selected statistics cited, inconvenient ones waved away).

In 2012, California voters faced a ballot measure to require labeling of foods that contain GMOs. (The measure was defeated after a very costly “No” campaign bankrolled by Big Food.) And oh looky here: Kevin Dietly was a hireling of the “No” campaign, and offered a very high estimate of the cost of GMO labeling — as much as $400 per year for each California household. His estimate was based on the assumption that producers would universally switch to costlier ingredients in order to avoid the GMO label (a dubious assumption at best), although he admitted that “We certainly don’t know what will happen.”

Speaking to Nevada lawmakers in 2011 on the subject of recycling and bottle deposits, Dietly positioned the beverage industry as having been “among the leading packaging innovators of the past 100 years,” and touted the industry as supporting a range of programs “to promote recycling.” And then he makes forceful arguments against deposit laws. If you read through his testimony, there are striking parallels in method, style, and type of argument with today’s testimony against the beverage tax.

In 2014 he addressed Connecticut lawmakers about a proposal to expand the state’s bottle bill. He asserts that it would impose unbearable costs on manufacturers and retailers, and had the audacity to depict the deposit/refund system as “counter to the goals of sustainable recycling and materials management.”

In 2002 he spoke before a U.S. Senate committee (chaired by Jim Jeffords) which was considering a “Beverage Producer Responsibility Act.” The concept of “producer responsiblity” has been a mainstay of advancement in environmental law; in Germany, for instance, producers have cradle-to-grave responsibility for their products — from bottles to automobiles. Its economy seems to be getting along just fine, no?

But according to Dietly, such an act would have been costly to consumers and businesses, and had little or no environmental benefit. Hmm, if he thinks there’s a disconnect between the Ivory Tower and reality, I sense a greater disconnect between industry-funded experts and reality.

I could go on, but you get the idea. Kevin Dietly is a well-traveled, amply-compensated spokesflack for the beverage industry, fighting for its interests in legislative halls around the country. His testimony should be judged accordingly.