This commentary is by state Rep. Anne Donahue, R-Northfield, vice chair of the House Committee on Health Care.
As I stood up on the House floor early Friday evening to report the emergency response bill from my Health Care Committee, I shared that it felt a bit odd to talk about a crisis based on two people being sick in all of Vermont. But I pointed out that the time to make sure the lifejackets are on hand is when the boat springs a leak, not when it is sinking.
That is what the governor was saying at his press conference at almost the precise moment that I was speaking. Getting ahead of this can reduce how severely we might be affected. The more we learn how quickly the novel coronavirus can spread without detection, the more we recognize that steps taken to reduce that hidden spread now, are essential. That was as I spoke, Friday; now, as I write, the news has just broken of three new cases in Vermont, including the first in Washington County. That will undoubtedly continue to grow.
And would widespread illness with COVID-19 be all that bad for most of us? No; we might never even show symptoms, or just have mild ones. It is far less severe than epidemics we have faced in the past. For highest risk individuals, however, the death rate may be as high as 12 to 17 percent, Vermont’s Health Commissioner told us at a special hearing earlier this week. All of us, as a community, need to take the steps we can to protect our friends and neighbors.
Up until midweek, my committee was working hard at finishing important bills for this session, since the “crossover” deadline was Friday. Anything not out of a House committee and en route to the Senate by then would be dead for this year. We reversed course on Thursday, with all hands on deck to identify the kinds of steps that should be in place, if needed, to keep Vermonters as safe as possible. Knowing that we, too, needed to close down operations indefinitely to prevent spread of the virus meant that we had to have in place the tools that might be needed under an assumption that we would not be there to pass further emergency bills. (We officially closed for only a week. We will only know on a week by week basis, however, whether that will need to be extended.) So what did our 25-page bill propose? This is an outline of the types of steps it would establish. (The trigger for the authority it gives was an emergency declaration by the governor, and by the time we passed the bill, that trigger had just been pulled.)
Taking care of Vermonters means taking financial care of those who care for us. Much of our health care system operates on fairly slim margins. If a health clinic is suddenly seeing many fewer patients because they are staying at home, it loses its billable revenue. With only a few weeks cash on hand, that could result in closure. So, the bill includes giving our state Medicaid agency authority for steps such as prepaying claims or providing other advance payments, when deemed necessary. Empty beds at a nursing home because multiple patients are hospitalized? Reimbursement for the empty beds could be continued. These are just a few examples of the provisions in this category.
Access to care
Our state’s insurance oversight agency would have authority to direct insurers to waive or reduce co-pays and deductibles related not just to testing (no-cost access is already in place for anyone who requires testing), but for treatment of COVID-19, and to modify or suspend deductibles for any prescription drugs. Insurers could also be required to reimburse for services provided by telephone. If your doctor was herself quarantined, we need her to be able to function providing patient support.
Medicaid and private insurers would need to permit pharmacy refills in advance of the usual time frame, so that patients can get refills early enough to have what they need on hand if they are quarantined. Pharmacies would be permitted to extend maintenance prescriptions without a prescription renewal. (If your doctor is swamped with COVID-19 patient care, we don’t want him to be distracted by paperwork to renew the prescription you’ve been on for 10 years already.) It is worth noting that some of these steps have already been taken by many insurance companies on their own initiative.
Licensing and regulation
The Board of Medical Practice and Office of Professional Responsibility helped us to identify where they might need emergency authorities. Provider workforce shortages are a very real threat in an epidemic. The bill allows for actions such as expediting licenses for health providers who are retired, to come back to work, or to allow provider “scope of practice” to be wider than normal. Across the board, the Agency of Human Services would have the authority to waive regulations if needed to allow necessary services to continue under a reduced workforce and a need for flexibility. A crisis is not the time to fine facilities that fail to maintain a particular record keeping requirement when it needs all available staff to be providing direct care.
Rather than drafting separate bills, our committee incorporated issues from other committees. The authority to waive aspects of credentialing or facility regulations extends to teacher licensure requirements and child development providers. The authority to waive other regulations extends to all areas of the Agency of Human Services. Food support programs that are funded based on specific regulatory criteria, such as senior center-based or school meals, or that are limited to certain eligibility groups, can be adapted. We even slipped some motor vehicle pieces in – it has all become public health. Those involve flexibility on license renewals and a “free pass” for expired inspections.
The state has no authority to suspend immigration law, but we wanted to underscore the need to ensure that no one feel a barrier to being tested or treated to prevent further spread of the virus. Legal immigrants who are subject to rules that could have their status revoked because of using public services, or undocumented immigrants who could fear that federal authorities might use the crisis to have agents stationed at health care facilities, need assurances that our nation’s priority right now is public health. I headed up drafting of a resolution requesting that the federal administration repeat its actions at the time of the water crisis in Flynt, Michigan and in several recent hurricane emergencies by declaring that health care facilities are protected zones from immigration enforcement.
This, like our overall health emergency bill, passed unanimously.
We passed a separate bill brought by our Commerce and Economic Development Committee to try to intercept some unemployment issues. The bill would amend laws so that an employee who needs to leave to take care of an ill family member is not counted as “voluntarily” leaving and thereby disqualified from unemployment benefits. It also ensures that an employer does not have its “experience rating” impacted (rates increased) because of payouts resulting from COVID-19 due to quarantines or illnesses. Such increases could devastate a small business if there are widespread outages.
In addition, banking institutions met with that committee to ask legislators to pass the message on to our constituents: your banks and credit unions will stay open. That is federal law. You will have access to them. They encourage anyone facing an issue such potential late mortgage payments due to lost income to get in touch with your financial institution as early as possible.
A symbolic bill?
Despite the intense work of those two days, some of it may just appear duplicative of authority the governor already has in an emergency. In addition — something that stunned House members — the Senate went home long before we passed our bill. It cannot move forward until the Senate returns to act upon it.
There were a number of important reasons for the House to act. First, waiting to call back our body of 150 to pass emergency legislation at a future point is far more difficult (from the health safety perspective) than reconvening the 30-member Senate to finish up on our completed work. When the Senate reconvenes, potentially by next week and still before implementation is needed, these measures will be ready for its action.
In addition, although the governor’s authorities when an emergency declaration has been called are very broad, they are not unlimited. We want to make sure there isn’t a missing piece that ties his hands for necessary steps.
In some ways, one of the most important aspects is in reassuring the governor that we’ve got his back. He takes on massive direct authority, essentially usurping the democratic process during the course of an emergency. We voted Friday night to say, “We believe you need the clearest of authority to act where needed, and as the legislative body, we endorse and support your actions.”
Having all hands on deck — or rowing in the same direction — really matters in both the efforts to head off the worst potential outcomes and to be ready to act if needed.