PFOA Contamination Likely to Spur Legislative Action

The discovery of Perfluorooctanoic Acid contamination in southern Vermont drinking water has prompted legislators to examine whether more action is necessary to ensure safe drinking water. Although the Department of Environmental Conservation was happy to report that subsequent targeted testing across the state has not indicated additional PFOA contamination, the initial positive tests have shone a spotlight on chemical and hazardous substance oversight in the state.  

On Friday, the Senate Natural Resources and Energy Committee reviewed a compendium of current laws applying to hazardous substances in Vermont, and as the House Fish, Wildlife, and Natural Resources Committee did the day before, received recommendations for a legislative response from Vermont Conservation Voters and the Vermont Natural Resources Council.  Suggested action areas for the committees include a ban on PFOA, an expansion of Act 188 (a law that focuses on chemicals of concern in children’s products), and the creation of a citizen suit right to enforce state laws. Additionally, the committees are considering the revival of S.77, a bill requiring private well testing when homes are sold. A similar bill was passed by the legislature in 2011 but vetoed by Gov. Shumlin.

Some witnesses said that the federal Toxic Substances Control Act has failed to address the potential dangers of certain chemicals, and they want the state to step in and stop unregulated chemicals from entering the market. Representatives of Vermont’s DEC, however, said that they have been working at the federal level to address the law’s shortcomings and do not support a state-by-state approach to chemical regulation.

DEC General Counsel Matt Chapman also told the Senate committee that ANR Secretary Deb Markowitz has determined that PFOA is a hazardous waste under 10 VSA Chapter 159 when leaked into the environment and subject to liability provisions of state law. The agency will be initiating  rulemaking, which Chapman said can be completed in two to three months.  

The committees will continue to take testimony and explore options for action on the issue next week.

Workforce Housing Pilot Bill Advances

The House Ways and Means Committee has advanced a bill that seeks to encourage construction of new housing in designated downtowns for workers earning average wages. The bill, H.865, also extends a now-popular first time home buyer's tax credit program for an additional four years.

The bill would authorize funding for two pilot projects and create a preference for long-term affordability provisions. It would allocate $1 million of previously appropriated capital funding to the program, and it calls for a report on how the projects are impacted by long-time development constraints, such as Act 250 and mitigation of prime agricultural soils.

Ways and Means Approves Economic Development Proposal

The House Ways and Means Committee trimmed a proposed extension of the Vermont Economic Incentive Program from ten years to three and struck a tax credit for converting to an employee-owned company, but it did advance the House Commerce and Economic Development Committee's economic development bill, H.868, late Friday.  

After moving the "plain English rewrite" of the complicated program back into the tax statute, the committee’s amendment also added provisions calling for a study of several policies by a technical working group and a full audit of the VEGI program by the state Auditor of Accounts by Oct 1, 2019. The committee voted 9-0 for the bill with two members absent. The bill moves to the House Appropriations Committee next, where it has already been reviewed. Work has already been underway as well in the Senate Economic Development, Housing and General Affairs Committee.

GMCB Defends Regulatory Authority Over Hospitals

Green Mountain Care Board Chair Al Gobeille appeared before the Senate Health and Welfare Committee on Wednesday to brief the committee on the hospital budget review process and the surplus revenue at some Vermont hospitals. Last week’s announcement by the University of Vermont Medical Center to spend $15 million of its $29 million surplus on community programs roused the ire of lawmakers given the state’s financial struggles. Gobeille’s presentation can be found here.

Gobeille told the committee that budgeting is not an exact science, and assumptions made during the 2015 hospital budget review process did not come to fruition. Additionally, while the Affordable Care Act is working and more Vermonters now have health insurance, it is not in the markets expected. The state and hospitals assumed that commercial market enrollment would increase, but it shrank. It was assumed that Medicaid enrollment would decline, but it went up. Hospitals also experienced lower free care and bad debt than budgeted. Gobeille said although lawmakers are focused on those hospitals with surpluses, he is more concerned with the hospitals that have a budget shortfall. For those hospitals with a surplus, the question is whether they are charging the right amount for their services.

Gobeille said the board has the policies and regulatory authority to deal with hospital budgets and potential surpluses and deficits. The board plans to address this on a case-by-case basis.

Committee Questions Ban on License Plate Readers

A Senate-passed bill, S.155, that would ban the private use of license plate readers received a skeptical response from the House Judiciary Committee this week. Committee members questioned whether the state could legitimately ban a person from scanning an image that is publicly displayed. Other states that have enacted similar bans have been the subject of litigation.

The bill also includes provisions governing the disclosure of protected health care information, limitations on law enforcement use of drones, and limitations on the ability of law enforcement to compel production of electronic information.

Ban the Box Likely to Keep Moving

The Senate Economic Development, Housing and Community Affairs Committee has heard little opposition to a proposal that would prohibit prospective employers from asking about criminal histories on employment applications. In testimony this week, two business groups said they were neutral, three testified in favor and all agreed that the current draft would satisfy any concerns they once had.

Under the "ban the box" proposal, employers can ask about criminal records once they have scheduled an interview and can also ask potential employees to certify in writing that their claims are accurate. The bill, H.261, allows the two sides to engage in a dialogue about past convictions and their circumstances.

Gifford CEO Provides Assessment on Pricing Variations Among Hospitals

Outgoing Gifford Medical Center President Joe Woodin testified before the Senate Finance Committee on Wednesday on the hospital’s project to review pricing variations for medical services at hospitals. Woodin said, “I felt compelled to explain our pricing based on comments made at the hospital budget hearings … that Gifford is more expensive than the University of Vermont Medical Center and the insinuation that critical access hospitals are more expensive.”

Woodin provided the committee with a presentation that compares charges by hospital for physician services, outpatient procedures, and inpatient admissions. In some instances, Gifford’s prices are higher; in other areas they are lower. The hospital has made adjustments to move its prices toward the state average.

Woodin provided health care reform suggestions for the Green Mountain Care Board and the state:

• Strive for “similar” prices. This would be a huge step towards consistency and a “fair and equitable price.”
• Use the most recent data available when analyzing variations. The state could request and use the 2016 hospital outpatient charges.
• Audit and use analysts to look at the data that shows highs, lows, patterns, and outliers.
• Improve the data through questioning, prompting, and better techniques for collection.
• Use both a straight average and a weighted average to understand what most people are paying for these services.

Equipment Manufacturers Talk About Dealer Relationships

Equipment manufacturers began to weigh in this week on a proposed rewrite of state laws governing contract provisions between suppliers of farm, agricultural and other rural equipment and their dealers. The testimony came in response to a bill being pushed by the New England Dealers Association. The bill, S.224, has passed the Senate.

In testimony Wednesday in the House Commerce and Economic Development Committee, Richard Briggs of Kabota, Inc. and George Whitaker of CNH Industrial (Case New Holland and International brands) told the committee that words matter and some of the language in the bill may have consequences in economic development programs they participate in. They also described the suppliers’ need to cultivate strong dealers with solid technical, training, branding and marketing support from the manufacturer.

“When you look at the length of our relationship with our dealers, you have to question these findings,” said George Whitaker of CNH Industrial. “We try to work things out. We’re not in the business of putting dealers out of business, not only because of the cost to us but also because of our reputation. We are not inherently antagonistic.”

Panel Begins Deep Dive on Prescription Drug Disclosure Bill

The House Health Care Committee this week focused its efforts on H.866, a bill to require manufacturers of certain prescription drugs to report information to the Green Mountain Care Board on research, development, acquisition and other costs associated with the manufacture of the drugs and prices charged to purchasers. After initial approval by the committee, it was sent back for further consideration after some committee members expressed anger at the lack of committee process with the bill.

Pharmaceutical Research and Manufacturers of American Assistant General Counsel John Murphy testified in opposition to the bill. He said the pricing of prescription drugs is complex, the bill does not provide any valuable information to patients, and it will stand in the way of innovation. Murphy said pharmaceutical companies agree that the list price for drugs is misleading and that no individual pays more than 40 percent of the list price. He said if policymakers are interested in learning about the cost associated with prescription drugs they should review the annual reports required by the Securities and Exchange Commission which are publically available.

On Thursday, Green Mountain Care Board Executive Director Susan Barrett told the committee that contrary to her previous testimony, the bill would burden the board with another task, and it cannot absorb that work within its current budget. She said if the committee decides to move forward it will need to be more prescriptive on what drugs they would like to be analyzed. Committee Vice-Chair Rep. Chris Pearson, P-Burlington, suggested that the Medicaid office develop a list of drugs and that the legislature have the Joint Fiscal Office and Legislative Counsel staff provide the analysis required in the bill.

Biotechnology Innovation Organization State Director of Government Affairs Ritchard Engelhardt on Thursday told the committee that the transparency requirements proposed are unduly burdensome, especially on emerging companies with only a few products on the market. Engelhardt said the information identified by the proposed requirements does not address the value that an innovative therapy can have to an individual patient, especially one who has no other option.

Panel Deliberates Prescription Drug Out-of-Pocket Costs

The House Health Care Committee on Friday took testimony on S.216, a bill that would require health insurance plans to make information about their prescription drug formularies available to enrollees, potential enrollees, and health care providers for qualified health plans that are available on Vermont’s Health Benefit Exchange. An amendment proposed by the Shumlin Administration to limit the out-of-pocket maximum for prescription drugs was also discussed. The committee heard from the administration and the American Cancer Society on this issue.  

Agency of Administration Special Counsel Devon Green asked the committee to consider raising the cap of $1300 on prescription drug out-of-pocket costs. She said the cap raises other non-drug out-of-pocket costs for Vermont Health Connect plan designs to unsustainably high levels. Given the federal requirement of an out-of-pocket maximum, the limit to out-of-pocket prescription drug coverage may prevent plans from reaching the statutorily required actuarial level for bronze plans. As a result, insurers may not be able to offer as many or any bronze plans for 2018 or federal law may supersede Vermont’s current prescription drug out-of-pocket maximum. The amendment can be found here.

Green’s proposal would create a public process overseen by the Green Mountain Care Board to develop bronze plans with lower co-payments, deductibles, and co-insurance, but a higher limit on out-of-pocket prescription drug coverage. She said as long as it meets federal standards, there will be at least one standard bronze plan that will retain the limit on out-of-pocket prescription drug coverage for those Vermonters who need it.

American Cancer Society Director of Government Relations Jill Sudhoff-Guerin said the goal of the bill is to provide greater drug coverage and cost transparency to enrollees and potential enrollees based on the specific plan they have chosen or may choose. Guerin also addressed the administration’s proposal to increase drug out-of-pocket maximum costs. She told the committee that full transparency around the process is very important and that her organization wants to ensure that this legislative change would not allow for any additional changes without legislative action.