Meetings
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[Alyssa Black (Chair)]: Welcome back everybody. Sorry for the delay. It is still February 18 and we are starting, we spent yesterday, all afternoon, going over all of our budget asks and requests and governors recommend. And today we are going through and we are ranking each individual person's priority. I'll open it up for discussion first, in case anyone has any questions or wants to discuss anything. I have two items on here that I would like to discuss before we vote. Voting, here's how it works. And I gave Nolan a key this year. So everybody gets five, their top five priorities ranked one to five, whatever your most, like, this is my favorite top number one priority, that every single individual's person, they will get five points for a one, four points for a two, three points for a three, two points for a four, and one point for their number five. And then we take everybody's priorities, we add up all those amounts, and we rank the committee on one through five what our top asks are, or we rank all the things that got votes in the order of the number of points that each got. And then we submit this entire spreadsheet to appropriations and they will have the tally of how staunchly we favor something or would say agnostic on it. So, first of all, I wanted to open it up if anyone has any questions about any items. I will say that there's a lot of people who are around the room. So, you know, if maybe you're missing an answer to something, I could find somebody around the room that could answer
[Karen Lueders (Member)]: Are we allowed to explain our vote?
[Alyssa Black (Chair)]: Yes, we may explain your vote, absolutely. I have a point about a correction. Let's get the correction and then Val has questions. On the first line, B306, personal services, VLAHCA, that's not for the healthcare advocate. That's just Vermont Legal Aid. It's pure legal work. And it is a Medicare advocacy project contract that they're canceling. I just wanted to be clear that it's not for the Office of the Health Care Advocate, that they have a separate ask down. Anything else, Mike? Liz and Dale. Liz and the Dale. Of Mike, I'm sorry, Mr. Health Care Advocate, Did you get any clarification on umpteen different zoning nurses that apparently get funded from throwbacks and We all sorts of
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: think we did, but I'm about to get us through today. Okay. In short, they'd ask you for a $450,000 increase, that's about $203,000 in that line in general fund. If it's wrong, I'll have all corrected in the appropriations because we're still waiting for one plus fee, but I think that when you break it down between the board and AHS, that's sure.
[Alyssa Black (Chair)]: DFR? You
[Leslie Goldman (Member)]: said two zero three?
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I'm sorry. Yeah, don't think there is any DFR. There's no? No. They said they didn't have it. But I'm getting clarification. So that's where we're at at the moment, so that's what you can operate on until So
[Alyssa Black (Chair)]: what'd you know? 208.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: That could change. About 45%.
[Alyssa Black (Chair)]: I missed all that, but that's okay. I'm sorry. Essentially, asking to $450,000 but because of the mechanism and the way the Office of the Healthcare Advocates funded, it's not all general funds. Some of it comes from bill back from AHS and Fremont Care Board. Thank you. Val, I think I first place. It was regarding the DNA and stash and why they're not combined, why they would not do, but it's totally different entity. Lori, would you be able to take notes here? I looking at I have both B and A highlighted and Sash.
[Lori Houghton (Member)]: Yes. They're two different things. Yes. Yes. So Sash is the supportive home for low income seniors that is done normally in the residential buildings where people are where they're supported. And then there's also, they have components where people in the community can be supported by Sash too. Specifically low income seniors. Yes. Yeah.
[Alyssa Black (Chair)]: May I ask Brian? I know you're on Zoom. Do you have all your priorities spreadsheet? I I don't know if you had an updated spreadsheet since we were
[Brian Cina (Member)]: I'm driving, and I should be there in a few minutes.
[Alyssa Black (Chair)]: Okay.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: So I
[Brian Cina (Member)]: was I was hoping to do it in person, but if you need me to set speaker ray in before I get there, I'm here on Zoom. So
[Alyssa Black (Chair)]: No. That's alright. If you'll be here in a few minutes,
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: be fine.
[Brian Cina (Member)]: Fifteen to twenty minutes is my estimate if I don't speed, which I'm not.
[Alyssa Black (Chair)]: We'll go slowly. We'll explain our votes a lot. I want to talk about two. There any other questions I'm trying to ask? Anything or do you think they feel they're really clear? Go ahead, Leslie. I don't know
[Leslie Goldman (Member)]: the answer where I haven't heard it, but with the demise of One Care and the gap before plus or minus ahead, because we don't know, That just means that primary care practices are going have a cut in income. That's what I understand, right?
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: They're not going to get the Medicare portion of the ePrint payments.
[Leslie Goldman (Member)]: Do we know how much that is? Is that what this is? Know. Is it on here? Cause this is a big number.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: It's a new number.
[Leslie Goldman (Member)]: I'm trying to make sense of this number.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: That's fine. That's Lori, I guess that's perfect.
[Leslie Goldman (Member)]: Nope, I didn't see it.
[Francis “Topper” McFaun (Vice Chair)]: It
[Alyssa Black (Chair)]: is on the bottom of the second section, and it's mixed in with So it is not 7,700,000.0. Second from the bottom, page one. Oh,
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: that's different. I'm sorry. That's different.
[Alyssa Black (Chair)]: Do we have the missing Medicare per number per month?
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: The blueprint? I have blueprint numbers, I don't have the one here.
[Alyssa Black (Chair)]: Do we not have the blueprint on this sheet? The blueprint, we have blueprint numbers,
[Lori Houghton (Member)]: but no, it's not on here. Because we just found out that it's not funded.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Mr. Graham, it's funded through Medicaid, but not the gap, not the bridge.
[Alyssa Black (Chair)]: Yes, okay. Well, it's not on here right now, so I think we're going to leave it off and maybe If it's not on here and we haven't heard about it, but remember, this is just the beginning of the process, It goes on for a long time.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Okay.
[Alyssa Black (Chair)]: Anything else? Just other than the two things that I think we should talk about. Okay, so we have in the governor's recommended budget, they are recommending that we increase prescription co pays for people on beef farm currently there's a $1 copay and then a $3 copay. And they're requesting that we increase that copay from instead of $1 to $4 and $3 to $8 So
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I
[Alyssa Black (Chair)]: think that the testimony that we heard was that due to H. R. One, it requires that there is cost share, but we've always had cost share and that there wasn't anything in HR one that said they had to increase cost share. So I wasn't here yesterday when you all went through this, but was there a discussion on does it have to be four and eight? Didn't really discuss We
[Lori Houghton (Member)]: went through all of them, but we didn't actually discuss in detail any of them. But I think somebody said it didn't have to
[Alyssa Black (Chair)]: be really balanced. Right.
[Francis “Topper” McFaun (Vice Chair)]: It can be anything.
[Lori Houghton (Member)]: It can be anything. It And be anything. It is. It be It could be
[Alyssa Black (Chair)]: still what it is. Could be one and three,
[Karen Lueders (Member)]: it's like over
[Alyssa Black (Chair)]: Can I make a personal statement here? So why
[Francis “Topper” McFaun (Vice Chair)]: don't you not influence the people out
[Alyssa Black (Chair)]: there? I'm not, I'm not, I just, I had a, let's call them a constituent, somebody who's very, very close to me who actually works in the department at Diva that administers all of this. And she called me almost in tears and she said, Mom, pharmacies call. Think I just got my daughter in trouble.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: She's saying
[Alyssa Black (Chair)]: pharmacies call all the time and she says, Mom, they can't afford $3 now. They're never going to be able to afford $8 And I just, first of all, was a little overwhelmed because, oh, this is why I
[Francis “Topper” McFaun (Vice Chair)]: love
[Alyssa Black (Chair)]: daughter. But this is raising $8 to somebody who makes very little money, especially if you're on multiple prescriptions, chronic conditions, this is a lot of money to them. I mean, dollars 8 and you're not seeing like a lot? But that's a lot when you live.
[Karen Lueders (Member)]: And can I add to that, that you have to buy into a Part B program, so that it's already cost them that, then you're paying a premium for B Pharm on it, on top of this?
[Alyssa Black (Chair)]: So I think it's a little overkill, if you ask me. Oh, I'm not supposed to, I'm sorry.
[Francis “Topper” McFaun (Vice Chair)]: No, we
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: just, I'm thinking about B Pharm, of it, it's all Medicaid. Doesn't just for me.
[Karen Lueders (Member)]: Yeah, I heard that, yeah. It's all Medicaid.
[Alyssa Black (Chair)]: You can be at the lowest poverty level on Medicaid, and this would apply to youth too. And the other thing that I think is really important to remember, and maybe this is just a philosophical thing because We're facing the loss of so many federal funds. Remember, any time that the state of Vermont collects either premium or copay, that has to be shared with the federal government. So it's like a reverse FM. For every dollar we collect, we have to send 60¢ of that to the federal government.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: That's just bringing it up because it's co pay.
[Alyssa Black (Chair)]: I think it's on co pays, isn't it?
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Okay, I think I asked that question. So,
[Alyssa Black (Chair)]: I mean, the fact that we're cutting and putting on the backs of Vermonters, poor Vermonters, and then sharing it with the federal government is a little, don't know, disheartening. Daisy? Are you saying that if we do nothing on this line item, the state will be bringing in money from people on Medicaid Part D's co payments. They will be making money off of those co payments.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Is that
[Leslie Goldman (Member)]: Medicaid Part D?
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I think
[Alyssa Black (Chair)]: so. They will essentially be paying less for that prescription, which means they will be saving money on the prescription. Okay. And then part of that savings gets shared, state and federal. I'm going to make a recommendation that we might want to, and I don't know the numbers and how it would affect this line item budget, but maybe we suggest like a two to four. Recommendation on this particular line that we don't agree with four-eight, but that maybe we would be amenable to two-four. Will
[Allen "Penny" Demar (Member)]: those numbers differ if nobody has them in our top five? You're talking about changing the numbers two to four, is that going make a difference if it's not in our priorities?
[Lori Houghton (Member)]: This would be outside of
[Alyssa Black (Chair)]: our priorities. Get an extra one. Oh, okay. Yes. It's how I'm looking
[Lori Houghton (Member)]: at it.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Okay, I see. One moment. Okay.
[Alyssa Black (Chair)]: Go ahead, Leslie. I'd just
[Leslie Goldman (Member)]: like to make a counter thought. I think we should leave it as it is. I think poor people are really getting slammed, the price of fuel, the price of food, the price of everything, this is one place where we can say, we hear you, let's leave it as it is. Meaning the one and the three. The one and the three.
[Francis “Topper” McFaun (Vice Chair)]: Not just low income people,
[Alyssa Black (Chair)]: it's everybody. No, it's Medicaid. It's everybody who has Medicaid Or or is it just Medicaid? Yeah, this is the paschera, it's only paschera, you're dashed. What
[Francis “Topper” McFaun (Vice Chair)]: I'm thinking of is somebody who goes to work every day is
[Alyssa Black (Chair)]: Let's pull out, yes, let's pull out the chart.
[Leslie Goldman (Member)]: I just wait, I can
[Alyssa Black (Chair)]: Go ahead, sorry. No, it's fine. Okay. So, first of all, it would be for anyone on Medicaid, which is currently 138% of FPL. It would be on Medicaid working disabled, below 250% of SGL. It would be on age blind disabled, at or below poverty. Affected income limit, it would be on pregnant women below two thirteen, would be on children below three seventeen, it would be on Medicare Part D, so this is older Vermonters over the age of 65 or on disability to buy into B Farm, and they pay a premium based upon their income level below 225%. I pretty much covered almost everyone, right?
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Yeah.
[Alyssa Black (Chair)]: That's in other categories, but listen to it. Yeah, go ahead.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I'm getting from my peoples that there's no kind of probabilities for that particular disorder.
[Alyssa Black (Chair)]: Are you still suspended? Oh yes, I'm sorry. No premiums for Okay, so no children. So, that's what we're talking about.
[Leslie Goldman (Member)]: You say about 138% of FPL is on? Yeah, can't read that,
[Alyssa Black (Chair)]: believe me.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: For an individual with 22,000 a year, a family of four is 45,500 a year.
[Alyssa Black (Chair)]: I think I just think that in the spirit
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: of
[Alyssa Black (Chair)]: of supporting the governor's recommends and the challenges that Debra is facing. I mean, would love to keep it 1.3. How much would it add up to? Well, they tell you. $1,430,000 between state and federal.
[Leslie Goldman (Member)]: State is 461,000.
[Alyssa Black (Chair)]: I'm sorry, I'm looking at the wrong line. Sorry. I've got $8,000,000,000.461000. Base, I mean, general fund.
[Leslie Goldman (Member)]: And then the part that goes to the Feds.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: The part that goes to the Feds is basically, what they're doing is they're assuming a reduction of spending, they're not taking the copay, so this is, I think we were right, this is the fact they're They're assuming a reduction in their spending, and so because of that reduction in spending, they're also spending the rent be rentals. It's not like part of the premium is getting, going back, but they're reducing their spending. That's where the Make sure the purple red flag is. Yes. You
[Leslie Goldman (Member)]: can ask for a straw poll on that.
[Alyssa Black (Chair)]: Yeah, I think I'll ask for a straw poll. Do want to say something? I'm to ask for a straw poll on my proposal that we recommend to appropriations that it go from one to three to two to four, but not four to eight?
[Karen Lueders (Member)]: I'm going to second that.
[Alyssa Black (Chair)]: I don't think we need a second question. I'm going to ask for a straw poll, if you agree with me, raise your hand. If you don't, because you want to keep it at four to eight, don't recommend that. Wait, I didn't answer the question yet. Just said if you agree with it.
[Leslie Goldman (Member)]: Okay, there are three different options though. If
[Alyssa Black (Chair)]: you don't agree with that, don't put your hand up. For whatever reason, either you want it to be a $100 or $8 or $3, don't put your hand up.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Okay.
[Alyssa Black (Chair)]: One and four, right? One One and and four. One, two, three, four, 56, seven. Seven of us. Okay, blanket.
[Francis “Topper” McFaun (Vice Chair)]: Now, you want another from the floor. So then
[Alyssa Black (Chair)]: No. No. That means we
[Francis “Topper” McFaun (Vice Chair)]: can't bring up the other one.
[Leslie Goldman (Member)]: What do you mean? It was voted down. Not voted down. She voted down. Because the way she phrased it was, you accept this, a vote yes means two to four. A vote no means you don't want two
[Alyssa Black (Chair)]: to four. Means you don't want to change it from the one three it currently is, or you want the dollars to change don't want to change it.
[Leslie Goldman (Member)]: From your four to eight?
[Alyssa Black (Chair)]: No. Oh, from the one to three? Yeah, seven to four. Alright, moving So, the two eleven that's on here, it's at the very bottom. It's under DCF. It's in DCF, which means we didn't particularly hear about it that much. That's more of a human services thing. I'm requesting that we recommend this if they're able to use this surplus that's in the HIT fund as a one time.
[Lori Houghton (Member)]: So just so you know, this is on here twice. So it's in as a reduction of hours, but then on that back page, it's in as the Epic and two eleven integrationists. So I think we're saying we're okay with the reduction of hours, but we want the money for them to do the Yes. It would be two separate decisions. Exactly.
[Alyssa Black (Chair)]: You're right, because the, I'm sorry, the governor's recommend had just the reduction in hours, but then they came in and they said, hey, we're doing this integration thing. So those two work together hopefully we could use the HIT money in the surplus for this integration. So, if everybody's in agreement with that recommendation,
[Francis “Topper” McFaun (Vice Chair)]: then this would mean that the hours wouldn't be cut, right?
[Alyssa Black (Chair)]: Well, I think they're cutting anyways the base, but we're sort of making up for it with this one time money for this program that they're trying to get IT infrastructure to work. Let me glance. Okay, all right, I'm going to recommend that. Hey, anyone want to volunteer to go first? Copper.
[Francis “Topper” McFaun (Vice Chair)]: Mine as well.
[Alyssa Black (Chair)]: Okay, thank you.
[Leslie Goldman (Member)]: Are we just doing one?
[Alyssa Black (Chair)]: Remember talking, you only get five. He always starts to slit extra,
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I
[Francis “Topper” McFaun (Vice Chair)]: I've got six here. I'm only gonna do five. I just made a decision.
[Alyssa Black (Chair)]: Okay, remember the answer in the order that
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: you You like to have. One is 5. Speak slowly. Ready.
[Francis “Topper” McFaun (Vice Chair)]: One is 5. Are you ready? Yep. B311.
[Alyssa Black (Chair)]: Can you say what it says?
[Francis “Topper” McFaun (Vice Chair)]: Area Health Education Center, AHAC.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Education what? AHAC. AHAC.
[Francis “Topper” McFaun (Vice Chair)]: That's number one. The number one priority. Is someone keeping track of that?
[Alyssa Black (Chair)]: I am in Nolan Institute. Both Nolan and
[Francis “Topper” McFaun (Vice Chair)]: Number two, visiting nurses association. That's under reimbursement rate request.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: That's three point five percent. Yep.
[Francis “Topper” McFaun (Vice Chair)]: Three, support service, sash. Four, Vermont Free and Referral Clinics. Five of six?
[Alyssa Black (Chair)]: Just five.
[Francis “Topper” McFaun (Vice Chair)]: Five, I want care of partners.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: 3%, 300%?
[Alyssa Black (Chair)]: I was just wondering about a lot of that has to do with Dale.
[Leslie Goldman (Member)]: Just wondering if human services had a physician,
[Alyssa Black (Chair)]: They have heard the same testimony we've heard and they'll make their recommendations.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: They haven't done it yet.
[Alyssa Black (Chair)]: May I ask, Amy, is the ask to the Human Services Committee the same as they asked to us? Yeah, think that's in the right for cartoon, so it's 3.5 Okay. Anything you want to say anything, Debra?
[Francis “Topper” McFaun (Vice Chair)]: Do do you want us to talk about?
[Alyssa Black (Chair)]: If you feel like you wanna
[Francis “Topper” McFaun (Vice Chair)]: record Well, the I could do some of the light, oh yeah.
[Alyssa Black (Chair)]: So people could feel like they're hurt. Do I still have the light?
[Francis “Topper” McFaun (Vice Chair)]: I think that the AHIP thing, that addresses provider shortage. We've had it for a long while. We still have a shortage of doctors and nurses and I think that if we're gonna solve this healthcare problem and the cost of it, we have to have staff to do it. And people can't afford to go to school. So I just think that's why I had for years. Two, using nurses association, That allows people to stay at home, get treatment, it'll keep people out of the hospital because they'll have people coming in all the time to help them.
[Alyssa Black (Chair)]: Wait, what was that that you just explained? Oh, BNAs. BNAs.
[Francis “Topper” McFaun (Vice Chair)]: That keeps the cost down. This is all my opinion by the way.
[Alyssa Black (Chair)]: I'm sure there's data to prove.
[Francis “Topper” McFaun (Vice Chair)]: Yeah, there's data to it back then. SASH, it's probably one of the best programs that I've come across in my twenty years here to help elderly people. The services are provided right on-site, but they can be and they can be provided outside of school. So I think staffing is a very program. Vermont Free Plan, I've been in support of that since before it was created, as a matter of fact, Help create it. This does a wonderful job and that's especially important now where the price is so high, people can't afford healthcare. So I think this is an integral part of the healthcare system and a lot of people are served by this that may not be served.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Let's see, what's my last
[Francis “Topper” McFaun (Vice Chair)]: I'll check that. So this is a statewide thing, they need staff. We need to have more incentives to staff a lot of these places where the services are provided and the people that are in the place to provide the services. So I just think that that program along with BHEC is extremely important in providing the information and helping them afford things. So that's it. Thanks.
[Alyssa Black (Chair)]: What are doing in six now? No, you've It's not gonna get any points, but what
[Francis “Topper” McFaun (Vice Chair)]: we're Well, six,
[Alyssa Black (Chair)]: the
[Wendy Critchlow (Member)]: system. I'm going to
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Thank you.
[Alyssa Black (Chair)]: Okay. Thank you, Zhao.
[Wendy Critchlow (Member)]: B314 Team 2. I'll explain after. Number one is team two? Yes. I have B311A5. Reverse side, Vermont free and referral clinics. Next, I have SASH.
[Alyssa Black (Chair)]: And
[Wendy Critchlow (Member)]: visiting nurses. And I'll just go back. I'm just going I think they're all pretty self explanatory, but I'm going go back to team two. I think if this service had been maybe established only a couple of years ago, I may not have had my heart tugged. Twelve years, the connections. I really respect when people devote so much time and energy into something, and they see it grow and prosper. And I was sold that it's making a difference
[Alyssa Black (Chair)]: There.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Job. Just believe I could use those into AHEC, free and referral clinics, dash, and then VNAs.
[Alyssa Black (Chair)]: Let's go next. Go ahead, Wendy.
[Wendy Critchlow (Member)]: Wendy,
[Alyssa Black (Chair)]: go ahead, Thank you. Of course, this is the first time I'm having to think about these things, so it's very daunting. But my order is one, Visiting Nurse Association. Two, Vermont free, and fill the vapes. Three, and I did a blur, but maybe I'm not allowed to, it's B311, it's two items, but one being AHEC, and the other, the education loan payment system, but I'm thinking of those as one, and if they're not, I prioritize AHEC.
[Francis “Topper” McFaun (Vice Chair)]: So AHEC is three? Yes. Four
[Alyssa Black (Chair)]: is Sash.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: The stated loan repayment under President?
[Alyssa Black (Chair)]: If it can't be a combined three, then no, it's not. So four is Sash, and five is Vermont Care Partners. And I'm thinking of access to primary care, to the value given to folks that are receiving it, the quality all these programs here at the Institute for the Work and the Hoping Race. Deb, do you wanna go next? Sure. Okay. One visiting nurses association. Two is Sash. He is Vermont Care Partners. Four is the American Heart Association. And five is the Vermont Medical Society, American Association of Pediatrics. There's two for BMS. Wait, the top one, so you want a rate increase or you want restoration of some of their One Care funding, like a gap? The Diva professional fee schedule. Okay, so increase 2.67 inflationary adjustment for rates. Great. Wait, no one's talking to Debra. Yep.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: BNA Vermont Care Partners, American Heart Association, BMS rates.
[Alyssa Black (Chair)]: Yep. All set? Great. Who would like to go next? Perfect.
[Leslie Goldman (Member)]: Well, this is my sixth year and it's still daunting. Even daunting her, if there is such a thing.
[Alyssa Black (Chair)]: Because it's all good.
[Leslie Goldman (Member)]: I mean, it's important stuff that we've been asked to think about and address. And I tried to spend time thinking about sort of an overarching theory of how to approach it. And that was harder. That was really hard too. But I sort of landed on, you teach someone to fish kind of thing. So that's sort of where I landed. So my first one is VSAC and my second is AHEC. And that's because in all my years here, we've been suffering from workforce shortages. And we just need to address it. And I'm worried. I know we talked about, we heard that it might come through the transformation grant, but I don't know when. And there's people in the pipeline and I don't want to give up on them. And I feel like that would be really not good. So that's my one and two. From another mine, three is actually the HCA because of the amount of money that's saved through that office for Vermonters and the support that that population gets for all of us. I mean, I don't know how many people I refer to as an agency. It's crucial to the functioning of many families. I feel like people who work for the state get a standard increase in their salaries. I don't know what it
[Alyssa Black (Chair)]: is off the top of my
[Leslie Goldman (Member)]: head, but I feel like that also should apply here. So I'm supporting that. Who does that? ACA. ACA, health care advocate.
[Francis “Topper” McFaun (Vice Chair)]: Oh, okay.
[Leslie Goldman (Member)]: My fourth one is the VNA, because I agree with Topper that we need people to be home when they come out of hospitals and they need recovery support. And my fifth one was going to be the Medicaid reimbursement money. So now I have to come up with something fast because I really didn't.
[Karen Lueders (Member)]: I give you my six.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I
[Leslie Goldman (Member)]: just think that I'm going to don't know that it needs to be $7,000,000 so I'm just willing for some kind of number to support primary care practices in filling that gap. But it may or may not be that number. And probably not that number because that's huge. But I would like to support primary care once again. We need primary care. It's the infrastructure of our health care system. Which would you like to support? The professional fee schedule or
[Alyssa Black (Chair)]: permit? 77.
[Leslie Goldman (Member)]: Yeah, the 77. Some number.
[Francis “Topper” McFaun (Vice Chair)]: That's number five.
[Leslie Goldman (Member)]: Yeah, some number there. It doesn't have to be that. But at least if practice is given,
[Alyssa Black (Chair)]: The bridge funding.
[Leslie Goldman (Member)]: Yeah, some kind of support until that could be settled.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Can I read that to you?
[Alyssa Black (Chair)]: Yeah.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Number one is the deep sac, and then AHEC, and then HCA, increased DNAs, and then polypropylene for ACO.
[Leslie Goldman (Member)]: Yes.
[Alyssa Black (Chair)]: Thank you. Allen, you want to go next?
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Sure.
[Allen "Penny" Demar (Member)]: Okay. Number one, I put visiting nurses. That's dear to my heart at home. I've seen it operate. I've seen it do real good things. Number two, Vermont Care Partners. Number three, the Vermont Medical Society of the American Association of the $7,000,000 And I said if I'm going go with that one, then I'm go with keeping it going. So I went with four as the fee schedule and five was Sash.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I'll write back to you. Sure. DNAs? Yep. Wildcare Partners? Yes. Work for primary care plus ACO? Yep. EMS rates? Yep. And then, Zach.
[Allen "Penny" Demar (Member)]: Yep, thank you.
[Alyssa Black (Chair)]: Thanks Allen. I think you're welcome. Lori, do you want to go next? Sure.
[Lori Houghton (Member)]: I have community outreach in Chittenden County with a request for a language that they create a transition plan so that we can revisit this next year. It gets all the way through. It's one. Two is Sash. Three is bridges to health,
[Alyssa Black (Chair)]: four Bladder. Sorry. That's one of what? She hasn't said it yet because no one told her to slow down. Meters what? Bridges. Bridges.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: That's which delta is three. That's fine.
[Alyssa Black (Chair)]: You good? Four
[Lori Houghton (Member)]: is Vermont Frame Referral Clinics, and five is VSAC.
[Alyssa Black (Chair)]: VSAT, not the AHEC.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Yes. Okay. Can I read that to you? Sure. Outreach, Houghton County, Bash, Bridges, Preparable Clinics, recycle out.
[Lori Houghton (Member)]: Yeah, and can I just make this statement? Yes. I feel like, one, I was against the return to office initiative. And although it's not a ton of money that's now being put into leases, it is still money being put into leases that did not need to happen. And a couple of these things that were cut could have been funded if people were allowed to work where they were being productive. So I want to be very clear about that. And then the second thing, which is not on here, there are some big increases to the agency of digital services that have been unable to be explained. It was in the news that there is a lot of unknown about how ADS is charging and why it was such an increase. And I think just in what we look at, it was a couple million dollars. That's a big problem. I have not something we can take up in this committee. And bottom line is this budget request from the administration seem to be more focused on infrastructure and things instead of people. And we see that clearly with everything that's being cut here. And that is a big problem in my eyes. Thank you.
[Alyssa Black (Chair)]: Let's see. No, Wendy already went. That
[Lori Houghton (Member)]: Wendy went.
[Alyssa Black (Chair)]: Oh, that Wendy went.
[Wendy Critchlow (Member)]: That's Wendy.
[Karen Lueders (Member)]: My number one is the BLA Alphazita Healthcare Advocate. I don't know if I have to explain this, but I've been working for Diva for a long time, and this is my go to place. I still have PTSD from when the Affordable Care Act rolled out. And so I just What they do is incredible, and I appreciate everything. So that's number one. Number two, and I hate that all you people are in here, because I know I'm going to
[Alyssa Black (Chair)]: I'm sorry. I have to go
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: with the
[Karen Lueders (Member)]: community outreach for me too, and that is our town manager actually called me last night, and this is I didn't understand how valuable this really is, and I do now.
[Alyssa Black (Chair)]: It's in what governors recommend down here, the community outreach team. Cina Batesville. Number three has to be bridges.
[Karen Lueders (Member)]: Number four is staff. And number five, I'm having such a hard time with number five. I don't know. It's between visiting nurses and the education loan repayment. I just, I They're both our infrastructure for healthcare. Who's coughing over there?
[Alyssa Black (Chair)]: I'm thinking about the future,
[Karen Lueders (Member)]: my own personal health care, I'm going to go with visiting nurses.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Yes. HCA, community outreach, bridges pnx.
[Alyssa Black (Chair)]: Yes.
[Brian Cina (Member)]: So, I can go. Am I the last one?
[Alyssa Black (Chair)]: Yep. No, we should
[Francis “Topper” McFaun (Vice Chair)]: go. You
[Alyssa Black (Chair)]: and Daisy, and then I'm last.
[Brian Cina (Member)]: I assume you want to go last.
[Alyssa Black (Chair)]: Yes.
[Brian Cina (Member)]: Yeah, exactly. So I'm ready then. So I'm going to vote even though I'm going to vote to be a good sport and cooperate with the process, but I do so under objection, and I'll explain why at the end. Number one, the Vermont Free and Referral Clinics. Number two, Vermont Care Partners. Number three, two.
[Francis “Topper” McFaun (Vice Chair)]: Number four,
[Brian Cina (Member)]: Area Health Education Center Number Program five, Sash.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: From our three clinics, from care partners, team two, AI, Sash. Yes. So
[Brian Cina (Member)]: the reason that I object for this is not because I think that the process itself is flawed, but the premise on which the process is being based, which is that there's not enough money, or that we have to make cuts. Nolan might be able to tell me, I wasn't here to ask, so I don't expect you to tell me this, but I try to add up all the cuts and all the asks quickly, and it's 20 something million in cuts. I don't know if you can confirm what that number is, but 20 something million in requests. That's 40 something million that we are either gonna cut or not fund. In the big beautiful bill, the top 1% of Vermonters got a $201,000,000 tax cut. So if we just recuperate that money that's not asking anyone to pay any more than they ever paid, paying the same, we could fund this and still have 160,000,000 to fund other things. So it just it's like I feel like we are being played here. In fact, if you look at the top 20% of Vermonters' tax breaks, 736,200,000. At people over $500,000 a year, just those folks, the tax breaks are $280,000,000, just to put it in perspective. So even if we decided we're gonna give every everyone under $500,000 a year the tax break, but ask those over and pay the same they paid before, we would have $280,000,000. So in that context, it's very painful to be sitting here like King Solomon cutting the baby into pieces. And I say this with no judgment of us. Have to speak this because it's like I feel like I'm doing this under duress, that we've heard from the state economists before, I don't know if everyone has, that when you're in a tight spot, there's three things you can do. You can deficit spend, you can cut programs, or you can tax more. And when we deficit spend, it's sometimes as smart to go in the hole to keep a program open because cutting it, you lose all the investment you put into it. But and that's and that's like cutting programs is one of the least appealing things to me because when we cut a program, for example, team two, I'll use, because I is an just an example. However many years of investment in building a program cannot be quantified in that simple yearly budget cut. We're losing all the money we spent and more in capital that we in, like, human resources. And so for every single cut on this page, that applies. And so it's like, I respect that we're trying to be cooperative with the governor, but I I very much fundamentally disagree with the premise that there's not enough money. We are being turned against each other so that the people at the top exploit us worse than they ever have. And so on that note, thank you for listening.
[Alyssa Black (Chair)]: I appreciate your comments very, very much. Thank you. Daisy? My number one is the Vermont Care Partners, because I noticed all the state workers who do those same jobs are getting a raise this year, and the designated agencies staff aren't. So I think the 3.5% rate increase is a respectable request. Community outreach is my number two, because that's an incredibly important service to Windham. My mayor wrote us a letter you all read this morning. Bridges to Health is my number three. And Health Care Advocate is my number four. And the free and referral clinics is my number five. And I think those are all very important services. We've all heard why. And I think that those rankings reflect the needs of Woodlandscape.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Yes.
[Alyssa Black (Chair)]: Alright. All set? Yep. Okay. My number one is bridges. My number two is free and referral clinics. My number three is VNAs. My number four is the community outreach thing.
[Wendy Critchlow (Member)]: My number five is
[Alyssa Black (Chair)]: the office of a healthcare advocate, it's my number five. I thought I had a sixth one, but I found
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: it! Yes! So, briefly? Yep! Reclance? Yep. DNA Addison? Yep. We already like, fit.
[Alyssa Black (Chair)]: Yep. Okay. So, do I get you to explain why both? First of all, I really appreciate Lori making that. And I want to make a point. I had calculated out with the amount that had been put into the budget adjustment dollars 432,000 a year. That's how much we're just paying in rent. And if you recall, we asked a lot of questions about toilet paper and this office supply. 432,000 could have funded multiple things on here. And seven staff, I mean, they're asking for 12 staff positions. Could have funded four or five of those staff positions. Not to mention, I think that they're going to have trouble filling those 12 positions because they're already losing people because of the return to the office policy. So I want to make that point also that I hate that. Community outreach is incredibly important to my community. I have heard from many, many people. I know how vital it is, and I always say that you cannot replace it with crisis because when you respond with a crisis, it will become a crisis. You all know how I feel about bridges, and same with the free and referral clinics. They serve a need that nobody else serves to a population that has no options for accessing basic healthcare. I just think that the work that they do is amazing. I'm going to give close of the and As. I don't. And if this rises, I've heard it many times, I promise I will do a better job of advocating with house appropriations, that this is not the same as other items, which is what happened last year in budget. And then I would just say, I had a discussion, somebody mentioned to me the other day that the Office of the Healthcare Advocate is a lobbyist. And I don't dispute that at all. But I'll tell you what, one of the only people that is in this building that's a lobbyist who is his client and who is there that office's client and that office's client is for Monters. And I don't know a lot of other lobbyists whose entire job is to look out for Vermonters. And I think about all the things, Leslie, you mentioned this, in the last few years, if it hadn't been for the Office of the Healthcare Advocate, we wouldn't have the expansion of MSP, which has saved Vermonters tens of millions of dollars. We wouldn't have IHIP. We did a bill on Medigap last year that was brought to us. We have Charlie in here all the time who is saving and working hard to ensure that Romanos save on their prescription drugs. We have, I mean, Emma. All the things that they do in policy, and that doesn't include the people that we don't see who are on the phones every single day working for Vermonters. So that's why Mike's on my list. There. There's my Explain My Vroom. Oh shit. I'm done. Karen, talk her.
[Francis “Topper” McFaun (Vice Chair)]: I just want to say something to the committee as a whole. Now I could be wrong on this, we'll find out what happens. But we all, based on what I have, I would say if I vote, we all thought pretty much the same way on the top five.
[Alyssa Black (Chair)]: Pretty close.
[Francis “Topper” McFaun (Vice Chair)]: And to me, that's great. This was not an easy job. And we all came out voting for
[Alyssa Black (Chair)]: A lot of the similar things. Similar things. Yeah.
[Karen Lueders (Member)]: We're a great committee.
[Alyssa Black (Chair)]: Nobody gets back to me. I didn't wanna say nobody gets six votes and I don't even get a six vote. But if I hadn't messed up in my head the number, it would have been a heck. Just Lori's point of we're not investing in people. We have been working so hard on workforce. And when we say we value the workforce to have those be some of the first cuts, it kind of boggles my mind a little bit. Go ahead. I just wanted to say, I think the healthcare advocate is foundational to so much of the good work that happens. Mean, for me, it goes without saying that work should be supported. It's just done so much good. But it was in this process, just like, I don't know, I wanted to say it's, you start with that, and then, I don't know, I just think
[Karen Lueders (Member)]: it's very important as well.
[Brian Cina (Member)]: In the past, our budget letter has often included language expressing opinions about spending or bigger picture trends, etcetera, how would people feel about a few sentences capturing my point that was phrased in a way that was less inflammatory maybe, or less passionate? Like, for example, we were asked to accept x million of cuts, there were y million of requests. And in the context of this, we asked our committee to follow this process, and then you explain or something, or we were asked to pick five each or something. However, we would like to point out that if we recaptured all the Trump tax cuts, we could fund all these programs and avoid all these cuts.
[Alyssa Black (Chair)]: Typically, our budget letter, I think, starts with this is how much we've had in requests. Am I Don't we agree? Don't agree with the credit council.
[Lori Houghton (Member)]: I don't think that I usually put that in as
[Alyssa Black (Chair)]: much as something is think last year's when you expressed appreciation, I mean, you always expressed appreciation for the opportunity, you expressed some general principles and values. Yeah. And then we talked about. So we could put in our general principle.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I might recommend you don't put the number of value requests because we don't know I have verified numbers.
[Alyssa Black (Chair)]: Okay, I absolutely don't want to criticize it. But we usually do have a little blurb in there about our values.
[Brian Cina (Member)]: If people aren't comfortable, it's okay. To me, is, everything we do is political.
[Wendy Critchlow (Member)]: I take it back you did last year,
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: but I
[Alyssa Black (Chair)]: didn't tell what you were asked for. Yeah, I thought that there was a number, because the number kept changing at the last second. Maybe we won't do that this year for NOLA. Leslie?
[Leslie Goldman (Member)]: I'm not sure how to phrase it, but I agree with Brian in that we are being forced into this very stupid box. And I agree with Lori that of all the cuts are about things and not people, and it's all pretty heartbreaking, which is what I started with. I'd like our letter to comment on that if it's appropriate to think about what we were asked to do by the administration. Mean, go into appropriations. So they're the ones that are going to hear they
[Alyssa Black (Chair)]: know on some level. But I do think
[Leslie Goldman (Member)]: we have to think about opportunities to look at more revenue somewhere. It's not only about cuts. It's about how to like you said,
[Brian Cina (Member)]: Yeah. It's directly related to the Big Beautiful bill too, which is what these cuts are related to. It's all the same underlying policy decision that was made federally.
[Leslie Goldman (Member)]: Yeah, so it's a consistent theme of let's not support poor people, which of course is why I did my Medicaid vote. And I feel really bad about that.
[Alyssa Black (Chair)]: I have Topper, and then Lori.
[Francis “Topper” McFaun (Vice Chair)]: Go ahead, Lori. You go before me. We've been through this before.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I went through
[Francis “Topper” McFaun (Vice Chair)]: this last time.
[Lori Houghton (Member)]: You've been through this a lot. I do not think we should politicize this. I think we, in the past, have always said that we've made some comments about hard work. We support all of these things that are helping people. I think that's what we have to keep it to. We do not, in this committee, have the ability to raise revenue. And so therefore, I
[Alyssa Black (Chair)]: don't think we should comment on it.
[Francis “Topper” McFaun (Vice Chair)]: Okay. Thank you, Lori. You're well done.
[Alyssa Black (Chair)]: I'm all done.
[Francis “Topper” McFaun (Vice Chair)]: I agree with you all the way. That's not bad. No, that's what I was gonna say. I don't think we should mix it in here. Although I might agree with that.
[Alyssa Black (Chair)]: Well, think another thing is to consider that the budget that came to us, we have to assume that there were difficult decisions made there as well. And I don't want to imply that there weren't. I do not think the commissioner of mental health that sat here and told us about all the programs being cut, I don't think that was easy for them. And I don't want to even approach the idea that it was.
[Leslie Goldman (Member)]: I don't want to imply that that's what I'm saying. I think it came from above that. So the commissioners had a hard road, I get that. And this is what they were able to come up with in order to meet what they were asked to do.
[Alyssa Black (Chair)]: But it's heartbreaking. It is. And I think our process was amazing, and I really respect that. Like Alyssa said, most of our things came to the top. Were all pretty aligned. You said that. We didn't think I did,
[Allen "Penny" Demar (Member)]: but it's
[Alyssa Black (Chair)]: a pretty good point. We don't know the results yet, if you want We haven't got the results yet.
[Francis “Topper” McFaun (Vice Chair)]: Oh, I know.
[Alyssa Black (Chair)]: Dolan, would you like to announce?
[Francis “Topper” McFaun (Vice Chair)]: We're gonna check your figures.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I was brought to you, we're in lockstep. Here we go. Number one is the DNAs. Two is the Vermont
[Francis “Topper” McFaun (Vice Chair)]: Now you're going to accept it.
[Alyssa Black (Chair)]: I'll email
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: it to you. Two is Vermont, free referral clinics, free to sash. There was a tie for number four. Oh, that's a waste, thanks evenly. Oh, that's waste. That's one
[Brian Cina (Member)]: South five.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: So AHEC is Vermont Care Partners, five to four. And then five is Community Avenue.
[Brian Cina (Member)]: So then we're allowing six to go through. Mhmm. Because in an election, there's a tie, then the fifth one gets bumped out. Before it's
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Well, that's just kind of a bully. This is the human
[Leslie Goldman (Member)]: services. Just those. Mean Won't
[Alyssa Black (Chair)]: be on this four. Ties. So basically what we'll do is we'll just sort of list how many points each of these got and how they were all ranked. Because they should know that some other things had votes on them. But those are our top five.
[Allen "Penny" Demar (Member)]: Six. Are you going five or six now?
[Alyssa Black (Chair)]: If we have a tie
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: on one of Okay. With ties, you go Exactly.
[Brian Cina (Member)]: You won't sell the five.
[Alyssa Black (Chair)]: I think it should be fine. You could also just book. How
[Brian Cina (Member)]: about we just recommend 10?
[Francis “Topper” McFaun (Vice Chair)]: And then add a tie on.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: I don't think we should change the process now.
[Alyssa Black (Chair)]: We're gonna pick 10.
[Francis “Topper” McFaun (Vice Chair)]: We'll do another round of balloons. No, you
[Allen "Penny" Demar (Member)]: know what the sixth one is.
[Alyssa Black (Chair)]: No, I said each of you gets five. I didn't say we were gonna make only five recommendations. Oh yes. Say that again. We'll straw poll this, but I don't want to stroke poll it right now because we might have some language and I want to make sure that everybody's good and I want to make sure everybody's good with the letter that we send. So we'll draft up the letter and get this all drafted and tomorrow we'll squeeze in. I mean, it won't take us
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: more than a couple minutes
[Alyssa Black (Chair)]: And then we'll just drop the lip.
[Allen "Penny" Demar (Member)]: Can I ask what the
[Francis “Topper” McFaun (Vice Chair)]: sample means?
[Alyssa Black (Chair)]: Six-one, I think that is. Six-one, it's
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: beating me out. Community artery. Number five.
[Allen "Penny" Demar (Member)]: Community
[Alyssa Black (Chair)]: outreach.
[Nolan Langweil (Joint Fiscal Office/Committee Staff)]: Pre clinic,
[Alyssa Black (Chair)]: Okay, we will. Let's put it in. We can make as many recommendations as we want to. Alright, Everybody all set? Think we're gonna have a letter. We'll have a letter and then we will
[Brian Cina (Member)]: not No.
[Alyssa Black (Chair)]: So tomorrow's Thursday, only have afternoon committees. Don't forget. No, you're right. What is going on? Tomorrow, have all that stuff on the floor. We
[Brian Cina (Member)]: have a lot of important votes tomorrow.
[Alyssa Black (Chair)]: Still out of vibes, everybody, so just keep that in mind. Yes, of course you may.
[Francis “Topper” McFaun (Vice Chair)]: Listen, tomorrow, we'll just talk about how important it is to be here at 09:00 on the field. I'm bringing that message from the speakers.
[Alyssa Black (Chair)]: Yeah, it's incredibly important. It's very important that everybody is in their seat at nine ks. I'm always there. Alright, everybody, we can go off of live, thank you.