By Michael Bielawski, Vermont Watchdog
Lawmakers who heard Gov. Peter Shumlin outline his spending priorities in Thursday’s budget address on Jan. 20 had mixed reactions on how money should be spent.
To fix Vermont’s $68 million budget deficit, Gov. Peter Shumlin called for $30 million in increased revenue, but he also asked lawmakers to reduce the amount of new spending they planned to do this year.
Some lawmakers applauded his focus on money for causes like opiate addiction and human services. State Rep. Ann Pugh, D-South Burlington, who chairs the House Human Services Committee, was also pleased to see more money for social workers. Shumlin is proposing $8.4 million in additional funding to support children going into state custody.
“They absolutely need help,” said Pugh. “They carry caseloads of more than 17 or so families, well above what’s recommended for best practice. The work that they do is very difficult; sometimes it’s better if they go at it in pairs. The courts are backed up, so to increase staffing is very important.”
State Rep. Joseph “Chip” Troiano, D-Stannard, was happy to hear of more money going to treat opiate addiction. Shumlin noted he wanted to expand on the use of the overdose prevention drug naloxone, known by the trade name Narcan. “I’ve been involved in getting hundreds of people into treatment for opiate addiction over my prior career [as an investigator for a law firm]. It’s a sad state of events,” Troiano said. “When someone recovers it’s a real sense of accomplishment. Over the last three years since the initiative began, I’ve seen a considerable impact on availability of medication and treatment.”
Other lawmakers were supportive of Shumlin’s “all-payer” health care plan.
Under an all-payer model, the Green Mountain Care Board would control Medicare and Medicaid, which chronically underpay health care providers. In his address, Shumlin said the two government payers pay doctors between 40 and 60 cents on the dollar for treatment.
State Rep. Fred Baser, R-Bristol, explained how all-payer might look for hospitals.
“Based on a calculation, like the average number of patients on Medicaid a hospital has seen over the past several years and what dollars were spent, that hospital would receive a single dollar (lump sum) amount over the year,” said Baser. “All the Medicaid patients would receive care under that cost. So it would be up to the hospital how to allocate and spend that money because they aren’t going to get more — it’s not a fee-based thing.”
Baser went on to say the logic behind this system is it would be in the best interest financially for the hospital to give the best treatment and make the patient better, whereas with a fee-based system the financial incentive lies in providing as many services as possible.
State Rep. Kevin Christie, D-Hartford, said he supports the governor’s health care policies so far.
“A lot of us aren’t increasing our income the way we would hope to — family budgets are pretty tight. Like Shumlin said, it only takes one catastrophic injury sometimes to break the bank. So it would only make sense if there is something we can do to help as many people as possible, why wouldn’t you?”
But leaders of the House Republican Caucus warned that Shumlin’s budget represents a familiar pattern of raising taxes while making only small reductions in year-over-year increased spending.
The caucus pledged to work to rein in general fund spending, which Shumlin’s budget increases by 3.1 percent over last year.