Town Meeting Update

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Feb 29, 2016 No Comments ›› maxinegrad

Vermont-FlagVermont Is Trending Up in Inbound Migration

The Northeast continues to experience a moving deficit with New Jersey (67% outbound) and New York (65%) making the list of top outbound states for the fourth consecutive year. Two other states in the region — Connecticut (63%) and Massachusetts (57%) — also joined the top outbound list this year. The exception to this trend is Vermont (62% inbound), which moved up two spots on the list of top inbound states to No. 3.

“For nearly 40 years, we’ve been tracking which states people are moving to and from, and we’ve also recently started surveying our customers to understand why they are making these moves across state lines,” said Melissa Sullivan, director of marketing communications at United Van Lines. “Because of United Van Lines’ position as the nation’s largest household goods mover, our data is reflective of national migration trends.”

United classifies states as “high inbound” if 55% or more of the moves are going into a state and “high outbound” if 55% or more moves were coming out of a state.

Improving Government for Vermonters

How much does our state government do? How well is it done? Who is better off because of a given investment? These three questions are the drivers behind a growing effort to make government more effective and more responsive to Vermonters’ current needs. Every department is now engaging in Results Based Accountability (RBA) analysis to track the effectiveness of their work. Committees in the House are diving into departments’ existing programs and associated outcomes in a much deeper way than ever before. “What outcomes are we buying for this investment?” “Do these efforts match up with Vermont’s current needs?”, “Is there a better way to accomplish this goal?”, “Are there duplications that we could eliminate for efficiency?” These questions help us understand if a program could use restructuring or if it is even still needed. Policy committees are then prioritizing programs so that the budgeting committee can allocate resources to the most needed and effective policies and programs. We are still in the early stages of the process but it is yielding productive conversations and good initial results.

The goal is to improve program quality and efficiency as well as prioritize programs for investment so that our budget can truly reflect what our state needs the most. While this work doesn’t attract flashy headlines, it is the backbone of our job to make government work better and more efficiently for you.

Protecting Children from E-Cig Use

In Vermont, 30% of students have tried e-cigarettes, and out of that, 15% have used them in the past 30 days. Teenagers are now using e-cigarettes more than cigarettes and the trend is growing. Additionally, the more people using e-cigarettes in general raise questions about public health safety.

We are looking at two ways to tackle this. First, we want to make sure we are preventing kids from having easy access to e-cigarettes by moving them behind the counter at stores or having them in a locked container. Secondly, there is a growing body of evidence that there are second and third-hand dangers from the vapors from e-cigarettes. In order to protect public health, we are working on including e-cigarettes in our clean indoor air laws. Not only will this bill prevent kids from starting to smoke or “vape” and protect public health, but it will also save the state hundreds of millions of dollars in health care costs.

Health Policy: All-Payer Model

The Affordable Care Act has helped Vermont achieve one of the best rates of insurance coverage in the country. 97% of Vermonters have health care insurance. Controlling costs and improving health outcomes and quality are challenges that need addressing.

Our current system pays health care providers on a fee-for-service basis. A fee-for-service system has led to a greater quantity of more expensive services, a fragmentation in care, and a system that drives high cost. It would be easy to defend this kind of system if the data showed that the extra services lead to better health outcomes. However, data supports the conclusion that Vermonters would be healthier if rewards went to providers who helped prevent expensive health problems from emerging.

All-Payer health payment reform aligns every insurer (Medicaid, Medicare, private insurers) under the same payment system. In an All-Payer Model, unfocused care provided in an uncoordinated fashion will be costly to providers, while they will be rewarded for illness prevention and the promotion of healthy behavior.

Vermont has various all-payer model reforms unfolding already. We have three accountable care organizations (ACOs) functioning across the state. While each of these ACOs still operates under a fee-for-service model, they have shared savings programs that compensate providers for improving quality and containing costs. VT’s three ACOs are currently developing a path toward a unified ACO managing an integrated, statewide system of care. VT’s Blueprint for Health, which incorporates primary care, prevention, and care coordination while working with Medicare, Medicaid, and private insurers, is also laying the groundwork for the transition to an All-Payer Model.

Vermont is currently negotiating a waiver with the federal government to allow Medicare (a 100% federal program), Medicaid, and private insurers to align and coordinate incentives to providers. In VT’s All-Payer Model, Medicare beneficiaries would maintain the same protections, benefits, and doctors as required in the federal system.

The negotiation of the All-Payer waiver and the term sheet outlining the elements of the program has been confidential up until recently. Now that the finite elements of the GMCB’s model have become public, we welcome feedback from our constituents on this issue.

Independent Contractors

Worker’s Compensation and Unemployment Insurance are an employee’s safety net. An Independent Contractor foregoes that safety net. The social consequences are played out in our emergency rooms and public assistance. The State of Vermont’s default is everyone is an employee unless otherwise exempted.

In 2008 the Vermont Supreme Court issued the “Chatham Woods” decision. This effectively set the definition of “independent contractor” almost solely on the “nature of the business” as proof that the independent contractor is performing separate and distinct work from their client. The classic example is the roofing company who decides to work with roofers who are “independent contractors.” The Chatham Woods decision prohibits this practice, which seems reasonable at first blush.

However, take the situation with a General Contractor who wants to hire a specialty tiler when they lay regular tile in the normal course of their business. The specialty tiler would be considered an employee. In the emerging technology world, independent contractors abound. Many times a technology company will bring someone in with a knowledge base they would not necessarily carry year round. These folks too would be viewed as employees even though they have clients and work under a contract.

The challenge is to replace the Chatham Woods “nature of the business” test with one of two tracks. If an independent contractor performs work for a client that is clearly separate from the client’s, such as a web designer working with a retail store, the separate and distinct test is met. The second path is for independent contractors who are performing substantially similar work as the client. In this case, the contractor would file a trade name registration with the Secretary of State, work under a written contract and will have filed with the DOL their choice as to waiving worker’s compensation in a similar manner that LLC and corporations and their officers can.

There are three emerging issues of contention. Can you have multiple independent contractors who are performing essentially the same work? If a person works exclusively for one client over long duration performing substantially similar work does that mean they are truly independent? Is current enforcement and educational outreach adequate now?

Resources:

Health Insurance:

www.VermontHealthConnect.gov
(855) 899-2047

Legal Aid:

www.vtlegalaid.org
(800) 889-2047

Energy Savings:

www.efficiencyvermont.org
(888) 921-5990

Benefit Service Center (Food, Fuel, Etc.):

(800) 479-6151

Agency on Aging:

www.cvoa.org
(800) 642-5119

Community Action Council:

www.capstonevt.org
(800) 846-9506

Child Care Resources:

www.brightfutures.dcf.state.vt.us
(802) 262-3292