Health Law Tax Penalty? I’ll Take It, Millions Say

The architects of the Affordable Care Act thought they had a blunt instrument to force people — even young and healthy ones — to buy insurance through the law’s online marketplaces: a tax penalty for those who remain uninsured.

It has not worked all that well, and that is at least partly to blame for soaring premiums next year on some of the health law’s insurance exchanges.

“In my experience, the penalty has not been large enough to motivate people to sign up for insurance,” said Christine Speidel, a tax lawyer at Vermont Legal Aid.

Some people do sign up, especially those with low incomes who receive the most generous subsidies, Ms. Speidel said. But others, she said, find that they cannot afford insurance, even with subsidies, so “they grudgingly take the penalty.”

Too Soon: Could the Suicide of a Burlington Artist Have Been Prevented?

In this powerful article about the life and suicide of Burlington artist Darshana Bolt, Jack McCullough, director of Vermont Legal Aid's Mental Health Law Project, says that evaluating and caring for suicidal patients requires balancing their safety and their liberty.

Jack maintains that we need more alternatives to hospitalization for patients in crisis and that the only people who should be in hospitals are those who can't be safely treated elsewhere.

Read Excerpts:

Burlington artist Darshana Bolt spent most of the hot, humid day of July 13 at the Howard Center's crisis center on Pine Street. The 31-year-old woman had threatened to kill herself, which landed her in the six-bed ASSIST Program in the city's south end. Despite being under supervision, shortly before 7 p.m. she informed staff that she was going outside to smoke a cigarette.

She never returned. ...

While the Bolt family finds fault with ASSIST, mental health advocates defend it. The Howard Center's program opened at 851 Pine Street to provide short-term residential care to patients in psychiatric crisis whose needs are not as acute as patients who are treated in hospital psychiatric wards. ...

Vermont needs more such facilities, not fewer, said Jack McCullough, director of Vermont Legal Aid's Mental Health Law Project. Even after learning of the state's investigation of ASSIST, and expressing sympathy for the Bolt family, he said the answer isn't to push more people into psych wards.

"The only people who should be in hospitals are people who can't be safely treated somewhere else," he said. "So it's a good thing that we have these alternatives to hospitalization."

Facilities such as ASSIST can't legally force people to stay, but they can "follow them out of the facility and keep track of them and try and talk them into staying," McCullough said. Staffers can always call the police if they believe a more secure environment is required. ...

Evaluating and caring for suicidal patients requires balancing their safety and their liberty, McCullough explained: "It's a big, big deal to have ... the power of the state ... confine them against their will and then, even beyond that, potentially inject them with powerful drugs ... that change the workings of their brain. I think we need to be extremely cautious in taking that step for anybody."

That longer-term involuntary commitment is even more complicated — it requires a court process — is a good thing, McCullough added.

'Rooming house' bylaws draw discussion from citizens

After nearly two hours of heated discussion and comments from the public, the Springfield Selectboard voted 5-0 to adopt proposed amendments to zoning regulations for rooming houses. ...

Several voiced frustration at what they described as unregulated, unsupervised, crowded rooming houses. Others spoke up to advocate for residents who were low-income, elderly, transitional and in recovery and who may need a room to rent as opposed to a full apartment. Some said they wanted the people living in rooming houses or living transitionally, just out of prison, to “go home.” ...

Mairead O’Reilly and Springfield resident Jacob Speidel, who both work for Vermont Legal Aid, offered advice and cautioned the selectboard to seek further legal opinions on the wording of the amendments before making a final decision. O’Reilly said she had concerns related to federal law, and that enacting the ordinance as written could potentially expose town to liability. She also offered to share some of her writing in the field of opioid recovery to be included in the board’s consideration of issues.

Speidel, who represents low-income senior citizens, shared a concern that renting a single room is less expensive than a full apartment, and often, a room is what they can afford. He also said he was concerned the new rules would allow fewer rooms for rent.

Upon a suggestion from Speidel that the board send the document to the town’s lawyer for review before coming to a decision, to avoid any possible legal consequences in the future, McNaughton said the town’s attorney is “very aware” of the language in the amendment.

Grant Funds More Legal Services for Vermonters Facing Eviction, Debt Collection

Vermont Legal Aid’s partner organization, Legal Services Law Line of Vermont (Law Line) has received a two-year $246,034 Pro Bono Innovation Fund grant from the Legal Services Corporation to organize and manage clinics that focus on housing and debt collection cases in several counties. The grant provides an important opportunity for Vermonters who usually have to represent themselves in court against opponents who are represented by attorneys.

“The whole state of Vermont benefits when more Vermonters live in safe, healthy, and stable housing,” said Sam Abel-Palmer, Law Line’s interim executive director. “Children perform better in school, and families require fewer emergency health services. We look forward to being able to expand the successful housing clinic we’ve developed in Chittenden County to strengthen individuals and their communities in other counties. And we’re excited to have the opportunity to develop a new clinic focused on those whose lives and, in some cases, ability to earn a living are being impacted by unscrupulous debt collection practices.”

New all-payer health model under scrutiny

Several risks and concerns have been raised at recent meetings and hearings about the health care payment reform plan sought by Gov. Peter Shumlin, according to the Legislature’s Joint Fiscal Office.

Shumlin, who will leave office in early January, is seeking to transform the state’s health care payment system from the current fee-for-service, in which providers are paid for each service or procedure they perform, to one in which providers are paid based on their patients’ health outcomes. ...

[Shumlin's chief of health care reform Lawrence] Miller said a number of groups and stakeholders have provided letters of support for the all-payer model, including Blue Cross Blue Shield of Vermont, the Vermont Medical Society, Vermont Legal Aid, the Lake Champlain Regional Chamber of Commerce and many Vermont hospitals, among others.

'All-Payer' Health Care On The Way: What Is It?

Bob Kinzel hosted a discussion on Vermont Edition about the Green Mountain Care Board's expected vote on the all-payer model for health care funding, which would bring about a dramatic change in the way that health care providers are reimbursed, a change that purports to reward quality of care and not the quantity of services that are provided.

Guests included Green Mountain  Care Board chairman Al Gobeille; Paul Harrington, executive vice president of theVermont Medical Society; Julia Shaw, health care policy analyst at Vermont Legal Aid's Office of the Health Care Advocate; and Dr. Paul Reiss; chief medical officer at HealthFirst, Vermont's independent practice association to discuss what the all-payer model means and what the implications of the switch could be.

Listen to the 43-minute program

Bourgoin case raises questions about mental health screening

In the aftermath of a deadly crash Oct. 8 involving a wrong-way driver, questions have been raised about how health care providers screen people seeking treatment. ...

Jack McCullough, director of Vermont Legal Aid’s Mental Health Law Project, is often involved with involuntary hospitalization cases.

One of the biggest issues facing Vermont’s mental health treatment system, McCullough says, is a lack of resources at the community level.

A shortage of services in communities means that some people grappling with mental health issues cannot find support until their cases reach a serious level — at which point they are hospitalized, he said.

Room for Improvement & Room for None: Jimmo Ruling Directs Medicare Agency to Improve Its Educational Campaign Regarding the “Maintenance Coverage Standard”

As reported by the Center for Medicare Advocacy, “in an Opinion and Order released on August 18, 2016, Chief Judge Christina Reiss, who oversees the ‘Improvement Standard’ case (Jimmo v. Burwell, No. 11-cv-17 (D.Vt.)), ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), to comply with the Settlement Agreement that she had approved in January 2013.” ...

After the 2013 agreement was established, Michael Benvenuto, one of the lead attorneys from Vermont Legal Aid, stated that “[t]his settlement should send the message that denying Medicare coverage for a chronic condition is wrong.”  Similarly, even as the original settlement was being proposed, the New York Times wrote an editorial extolling the humanity of the rule change.  Together, these notions epitomize an ideal of human dignity that skilled care should be provided to the elderly or disabled, even when their condition may not improve.

Health Care Providers Say They're 'Cautiously Optimistic' About All-Payer Plan

A number of health care providers say they are "cautiously optimistic" that the implementation of a new payment system known as “all-payer" will help reduce costs and allow them to provide a higher quality of service. ,,,

Julia Shaw is a policy analyst in [Vermont Legal Aid's] Office of the Vermont Health Care Advocate. She says things definitely need to change.

"The cost of our health care system is growing too rapidly,” says Shaw. “And I think this is a promising way to address that and really start to bend that curve." ...

And Julia Shaw of the Health Care Advocate's office wants the “all-payer” system to include consumer protections to ensure that patients get appropriate care.

"In this kind of model, where providers are paid basically for treating a population, there are some financial incentives to provide less care," Shaw explains. "So really what the model needs is checks and balances to ensure that patients get the care that they need."

Read our white paper: Consumer Principles for Vermont's All-Payer Model

Driver restoration is a road to opportunity

In this op-ed piece, Vermont Legal Aid attorney Christopher Curtis writes:

A year and a half ago, more than 1,000 Vermonters turned out on a chilly March day in Burlington to get square with the law, pay their traffic fines at reduced rates and get back on the road safely, legally, and affordably. A bright tapestry of Vermonters from all walks of life waited patiently for a second chance to reinstate their driver’s licenses. People came from five counties – one all the way from West Virginia – for a “Driver Restoration Day” project initiated by Chittenden County State Attorney T.J. Donovan. ...

The scope of the license suspension problem is staggering. According to the Department of Motor Vehicles, about 60,000 Vermonters have suspended licenses. More than half of those are simply for failure to pay a fine. Most of those are low-income Vermonters who simply cannot afford to pay and then find themselves in a downward spiral of new tickets and fines following the original infraction. ...

The new law is not a free pass. All drivers remain obligated to pay fines and are subject to a “points system” for infractions. So, repeat offenders are still subject to suspension for failure to comply with our traffic laws. But, flexibility in the system will put low-income drivers on more equal footing with others to be able to simply pay their fines and move on with their lives.