News

Outlook: Vermont on the brink of an Affordable Care Act repeal

With an Affordable Care Act repeal on the horizon, Vermont’s leaders are trying to predict the future amid changing messages coming from Washington.

“People want certainty, and there isn’t any,” state Sen. Jane Kitchel, D-Caledonia, chair of the Senate Committee on Appropriations, told Watchdog. “One day, [Trump] is talking about repealing the ACA, and then he says he wants to provide coverage for everyone. At this point, all we can do is track the situation closely.”

According to the George-Soros-funded Center on Budget and Policy Priorities, Vermont is poised to lose $3 billion in federal funding over the next 10 years if the law is repealed. Moreover, 35,000 Vermonters stand to lose insurance coverage....

While Vermont operates a state health care exchange, the state is intricately connected to the ACA through Medicaid.

Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities, a progressive think-tank focused on policies that impact low-income Americans, told Watchdog that each state will have to evaluate the greatest areas of need based off of individual demographics. In Vermont, that demographic is likely to be low-middle-class Medicaid users.

Vermont has the most expansive Medicaid coverage of any state. The ACA expanded eligibility for low-income adults, but Vermont also negotiated a global commitment waiver with the federal Centers for Medicaid and Medicare Services. The waiver further expanded Medicaid coverage by allowing the state to determine wider eligibility and finance programs like the Blueprint for Health.

Because Medicaid is so expansive in Vermont, certain brackets of beneficiaries are likely to face cuts. ...

Republicans have proposed dramatic changes to Medicaid structure, such as giving states control through block grants. Past Republican budget proposals have also included a per-capita spending cap intended to reduce spending by $1 trillion over 10 years. Critics say the funding reductions will hurt states’ abilities to continue with innovative health programs, such as Vermont’s Medicaid waiver. [...]

Michael Fisher, chief health care advocate at Vermont Legal Aid, a nonprofit law firm created by the Legislature protect Vermont consumers, said his office is ready for whatever plan Republicans present. “We will work with every fiber of our beings to make sure we have improved access to care,” he told Watchdog. [...]

Fisher encourages Vermonters to contact state and federal representatives if they are concerned about their health care. Since no one knows the future, elected officials need to know “what does the average Vermonter feel.”

The Shumlin Legacy: A governor who wasn’t afraid to think big

...at the start of the 2013 session, Gov. Shumlin ... proposed shifting money from the Earned Income Tax Credit to child care subsidies... Christopher Curtis, an attorney with Vermont Legal Aid, led the fight against the proposal, which the governor dropped several days later.

“I think Peter Shumlin really listened and learned on the job. I went from being pretty critical of the administration on some of these early calls and early challenges” to supporting the governor’s poverty-reduction efforts. Curtis praised Shumlin’s decision, after the policy misstep, to form a poverty council on which Curtis serves to get more input on ideas.

Curtis had mixed feelings about Shumlin’s overall efforts to help low-income people. He praised the administration’s work immediately after assuming office.

“They deserve a lot of credit for really maximizing the monies that were available to help take what could have been a precarious recovery that could have gone backwards and really help stabilize the situation for many thousands and thousands of people,” he said.

On spending, Curtis said Shumlin and lawmakers operated with a “budgetary straightjacket” and that there was too much reluctance to discuss raising taxes.

“We’ve been fighting budget battles with one hand tied behind our back for a long time. We’ve had 40 years in this country of people saying public investment is bad, taxes are bad, without a robust discussion,” he said. “Part of the deal with a social contract is that we do together as a community what we can’t do individually.”

Can poverty be eradicated? Chris Curtis on the enduring challenge

Christopher Curtis, staff attorney at Vermont Legal Aid and co-chair of the Governor’s Council on Pathways from Poverty, has dedicated his life to eradicating poverty. Though he has never held elected office, Curtis has been the force behind many key policy changes made on behalf of low-income Vermonters. [In this recording of an interview that was first broadcast on December 14, 2016], he discusses the final report of the Governor’s Council, his life, and why he keeps fighting for the poor. Whitney Nichols joins the conversation to talk about his experience being homeless in Vermont and his work with Curtis on the Governor’s Poverty Council.

Listen to the interview

Change In Vt. Medicaid Policy Could Improve Access To Live-Saving Hepatitis C Treatment

A change in Vermont’s Medicaid policy could soon deliver potentially life-saving treatment to many low-income patients with hepatitis C. But the reform won’t come cheap, and even with the changes, many patients still won’t have access to the costly cure. ...

But last week, the state’s Drug Utilization Review Board voted to change the policy. And the drugs will now be available to people with damage scores of F2 or worse. The policy previously reserved treatment only for patients with scores of F3 and F4, which denotes severe liver damage.

“A score of F2 indicates that the liver ... there already is some damage beginning there, but it is less severe damage than Medicaid had required previously,” says Julia Shaw, a policy analyst with the Office of the Health Care Advocate.

Shaw’s office had also been pushing the board to lift a requirement that patients be drug- and alcohol-free for six months prior to receiving treatment. Shaw says there’s no medical evidence that even injection drug users suffer higher rates of re-infection than people who remain abstinent.

The board agreed.

Steven Costantino, commissioner of the Department of Vermont Health Access, says he’ll take steps to institute the reforms voted on by the board.

Advisory board urges expanded access to hepatitis C drugs

An advisory board says the state should make it easier for Vermont’s Medicaid patients to get access to expensive prescription drugs that treat hepatitis C. ...

The vote follows more than a year of advocacy from a coalition of organizations led by Vermont Legal Aid’s Office of the Health Care Advocate. The coalition includes the American Civil Liberties Union of Vermont, the Prisoners’ Rights Office and the Vermont People with AIDS Coalition. ...

Julia Shaw, a policy analyst for the Office of the Health Care Advocate, said the state and society in general are tolerating limits on treatment for people with hepatitis C because the disease still carries a stigma. ...

From our perspective, we don’t punish people for their other behaviors,” Shaw said. “We don’t withhold treatment for lung cancer because someone smokes, or we don’t withhold treatment for diabetes because somebody didn’t eat right or didn’t exercise.”

“I don’t think people would tolerate this type of rationing of medication based on the cost for cancer — pretty much for everything else,” Shaw said. “The only explanation is because it’s a stigmatized disease.”

5 questions facing Phil Scott and the new Legislature

Gov.-elect Phil Scott didn't hesitate on Monday when a reporter asked him his greatest challenge these days. "Lack of time," Scott said. ...

Workers in Vermont will soon begin to earn paid sick time under a state law that takes effect January 1. Many of the groups that pushed for the new sick time law are already preparing to ask for another family-friendly policy: paid family and medical leave.

The coalition, which includes Main Street Alliance, Voices for Vermont's Children, the Vermont-NEA and Vermont Legal Aid and AARP-VT, argues that Vermont employees should be eligible for paid time off when they have a child, or when they are going through a major medical event. Other states have a version of this insurance program, funded by the employee or by a combination of the employer and employee.

Vermont Supreme Court Decision Expands Access To Health Care Subsidies

A case decided by the Vermont Supreme Court earlier this month will serve as an important precedent for some Vermonters hoping to buy subsidized health insurance through Vermont Health Connect. ...

“So, J.H. was denied subsidies because her husband had access to health insurance through his employer,” said Christine Speidel, a staff attorney at Vermont Legal Aid who represented J.H. in the case.

But J.H.'s husband wasn't using his employer's health plan, and because of that, J.H. couldn't use it either. ...

“So the question was: Does that offer of insurance to her husband – which the husband didn't take, for his own reasons – does that disqualify J.H. from getting subsidized health insurance through Vermont Health Connect?” Speidel said.

Distance, disabilities and debate

After several months of public discussion, the Springfield Selectboard will move forward to yet another hearing for a proposed bylaw ordinance amendment for rooming houses, with a 1,000-foot distance provision stricken from the draft. ...

Selectman Peter MacGillivray said that the fact that a few lawyers in the room — including two with Vermont Legal Aid — were not comfortable with the “disabilities” wording caused him to be cautious as well.

“I don’t want [the town] to get sued,” he said. ...

Jacob Speidel, an attorney with Vermont Legal Aid and also a Springfield resident, also said during the public hearing that the 1,000-foot rule language in the amendment originally warned for Dec. 12 could expose the town to liability under the Fair Housing Act.

Marilyn Mahusky: Aiming for equity in education

Editor’s note: This commentary is by Marilyn Mahusky, a staff attorney with Vermont Legal Aid’s Disability Law Project.

The central purpose of proposed State Board of Education Rule 2200 is to ensure equity and equal opportunity for all students, including students with learning differences. It is about inclusion and prohibiting exclusion based on disability by independent schools that accept public funds.

Students with disabilities comprise about 15 percent of Vermont’s student population. This includes students with a range of learning differences from mild to severe. These students live in our towns and communities; they are our neighbors, perhaps even our own children and grandchildren.

Read the complete commentary

Medicaid review board votes to lift some restrictions on life-saving cures for Vermonters with hepatitis C
At its meeting on December 6, Vermont Medicaid’s Drug Utilization Review Board (DURB) voted to lift some of the restrictions that currently prevent most Vermont Medicaid patients with hepatitis C from accessing life-saving cures. If the DURB’s recommendation is accepted by Department of Vermont Health Access Commissioner Steven Costantino, many more Vermonters on Medicaid who have the life-threatening disease will gain access to treatment. According to the CDC, hepatitis C kills more Americans than any other infectious disease and Baby Boomers are most at risk.

Vermont Legal Aid’s Office of the Health Care Advocate and a coalition of organizations sent a letter to the DURB in late October asking the Board to review and remove all restrictions on hepatitis C medications that deny patients access to medically necessary care and cause unnecessary harm to Vermonters. ...

Julia Shaw, a policy analyst with the Office of the Health Care Advocate, said, “We were hopeful that the DURB would lift all the restrictions as other states like Massachusetts and Connecticut have done, and as we believe is required by federal Medicaid law. However, this is an important step in the right direction. We are very happy that the DURB lifted the sobriety requirement, which is particularly arbitrary and punitive to people, many of whom are unable to access substance abuse treatment.

Ensuring that more patients can access curative treatments for hepatitis C will benefit those individuals greatly and will help prevent new infections.”

“We’re pleased that the DURB voted to revisit the issue within the next six months to consider expanding access further,” Shaw added. “Federal courts, national medical guidelines, and other state Medicaid agencies have recognized that treatment of every patient with hepatitis C is the standard of care. There is simply no medical reason for Vermont to withhold access to this cure.”

“Commissioner Costantino acknowledged in remarks last week that those who have hepatitis C should have the opportunity to be cured of hepatitis C – and that it’s morally the right thing to do. We’re hopeful that he will not only accept the DURB’s recommendations, but also move as quickly as possible to make treatment available to every Vermonter who needs it,” Shaw said.

This article was the lead story in the Vermont Biz eHealth newsletter, which is distributed every Tuesday. Vermont Business Magazine included additional information from the CDC and other sources about the scope of hepatitis C infection and risks, along with this quote:

“Why are so many Americans dying of this preventable, curable disease?” asked Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Once hepatitis C testing and treatment are as routine as they are for high cholesterol and colon cancer, we will see people living the long, healthy lives they deserve.”

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