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.”

Some Americans are Choosing to Take a Tax Penalty Instead of Buying Health Coverage

It’s possible that the Affordable Care Act (ACA) – also known as “Obamacare” – may be an endangered species. And those who have called for a repeal have one specific element that draws their ire: the individual mandate. But it turns out, the government’s requirement that Americans buy healthcare plans may not exactly be working as expected anyway. ...

I recently spoke with Christine Speidel, a tax lawyer at Vermont Legal Aid. She explained to me that the tax penalty was largely created to spur citizens who have been known to forego health coverage, most notably young and healthy ones, to enter the “risk pool,” which would help cover the more popular components of the law, like coverage for those with pre-existing conditions.

“In order to make this work as a private insurance market, you have to have a viable risk pool,” Speidel explained. “Which means you have healthy individuals in the risk pool as well as sick ones.” ...

So if the ACA needs everyone to buy in for it to work, why not just simply raise the penalty to a level that Americans would actually feel? Speidel says it’s not that simple.

“That might work for people who have higher incomes. But for people who are already feeling like they can’t afford insurance, increasing the penalty may just lead to resentment and huge tax bills,” she said. “If the penalties were equal to the premiums, there would be no incentive for those who can afford it not to purchase insurance. But for those who truly can’t afford it, that would be terribly unfair and punitive. Raising the subsidy levels would also help with compliance and improve the risk pool. ...

“I think it’s too soon to say what effect a Trump presidency will have on the ACA, but it’s interesting that both Mitt Romney, when he enacted a similar plan to the ACA when he was governor of Massachusetts, and President Obama, when he started to draw up the ACA, were against some sort of mandate. But when the economists and the actuaries ran the budgets, it became hard to have a bar against pre-existing condition exclusions without having some sort of mandate.”

CONTACT:   Eric Avildsen, Executive Director

Former State Representative Michael Fisher to Join Vermont Legal Aid as Chief Health Care Advocate 

Former state representative Michael Fisher will join Vermont Legal Aid as Vermont’s Chief Health Care Advocate on January 2. Fisher will lead the Office of the Health Care Advocate, which was established by the legislature in 1998 to assist Vermonters who have questions and problems with access to health care services and health insurance and to represent the health care interests of all Vermonters in the legislature and before state agencies.

Fisher was elected seven times to represent Addison-4 in the state legislature. He served in a variety of leadership roles including chairing the House Health Care Committee for three years and serving for six years as vice chair of the House Human Services Committee. Fisher played a key role in the passage of legislation that reduced Vermont’s uninsured rate from seven percent to three percent by establishing Vermont’s health insurance marketplace and expanding Medicaid. He also helped write and ultimately pass legislation that created the Green Mountain Care Board whose purpose is to reduce the rate of health care cost growth in Vermont while ensuring that the State maintains a high quality, accessible health care system.

Having worked as a community social work clinician for over 25 years, Fisher has direct knowledge of the multiple and complex health care and human service needs that many Vermont families face and the critical role the Office of the Health Care Advocate plays in assisting them.

“Mike brings a deep understanding of Vermont’s health care laws, the legislative process, and the numerous challenges that many struggling Vermonters face on a daily basis,” said Eric Avildsen, Executive Director of Vermont Legal Aid. “We are especially pleased to have someone with Mike’s experience during this time of great uncertainty for many Vermonters who are worried about losing the insurance they finally were able to obtain.”

“I look forward to being a strong, independent voice for Vermonters,” Fisher said. “This is a particularly interesting time to be involved in health care advocacy. I’m proud that Vermont has been a leader in expanding access to health care, yet we know that the cost of getting care is still too expensive for many.  As the state is poised again to lead the nation by implementing the All-Payer Model, we will evaluate critically the potential role of the private sector in payment and delivery reform, the intricacies of the model, and how to ensure that there is a transparent process where Vermonters are protected.”

The Office of the Health Care Advocate (HCA) helps Vermont consumers with a broad range of problems and questions related to health care services and health insurance. The HCA acts as a voice and advocate for consumers in health care policy matters before the Vermont legislature and government agencies that oversee insurance and health care programs. The Office of the Health Care Advocate is a project of Vermont Legal Aid.

Vermont Legal Aid (VLA) is a non-profit law firm that provides legal advice and services to individuals and families throughout Vermont who are facing a civil legal problem that threatens their rights, shelter, job, health, or well-being. VLA began serving clients in 1968.