Emergency services or life threatening infections and stuff like that. Was overturned: The courts were asked to overturn them.
That panel has responsibility for making financial decisions when the full Legislature is out of session.
Among the cuts were eliminating state coverage through Medicaid of adult chiropractic care, denture services and some elective inpatient surgeries...
He also argued the administration improperly adopted emergency rules for implementing the cuts in violation of state law requiring that the public have input into such decisions.
Emergency rules are permitted when there’s “imminent danger to public health or safety,” McCullough said. “We claim that ... the possibility of a budget deficit doesn’t qualify under that standard.”
http://rutlandherald.nybor.com/News/AtAGlance/Story/56109.htmlHere we go again. Last February, this column described Gov. Howard Dean's proposal to cut drug assistance programs for seniors. In spite of arguments highlighting the hardships this would cause older people with low incomes, legislators eventually increased co-pays and added a deductible. This year, these same programs are facing the budget ax once more. The arguments for cuts remain the same. Medical inflation, especially the escalation in the price of medicines, plays havoc with the budget for state programs that help low-income people pay for their health care. The arguments against cuts have usually focused on compassion and need. Medicare does not cover medications, and seniors, on average, are paying more than $1,000 per year out-of-pocket for their drugs. Most cannot afford it, and many are forced to choose between medicine and food.
Recently, advocates for seniors have expanded their arguments to the supply side: Balance the budget by cutting drug costs, not benefits. Watch out for the unintended budget consequences of limiting drug use for frail seniors.
Until recently, only Vermonters with very low incomes and eligible for Medicaid were able to receive public assistance to help pay for their prescription drug costs. After much legislative discussion and advocacy by seniors in the past decade, Vermont now has three pharmaceutical assistance programs that help people with slightly higher incomes. About 15,000 older Vermonters with incomes up to $20,000 (one person) or $27,276 (couple) receive state assistance in paying for prescription drugs. People at the top of the eligible income group receive the least help.
http://www.biohope.org/media/article.cfm?articleid=3368&state=VTDr. Thompson gave some background on the issue of OxyContin prior authorization (PA), explaining that VMS members had been working with Medicaid Medical Director Joe Jacobs, MD, to improve the OxyContin PA form and to try to use the Medicaid PA as a tool for educating physicians about quality pain management. Governor Dean said he thought imposing the new PA requirement had been a very positive step for the state. Dr. Thompson noted that the publicity around OxyContin abuse and diversion had a chilling effect on Vermont physicians who were beginning to better treat pain. Bill Roberts, MD, a St. Albans anesthesiologist, said that physicians have been thoroughly educated about what not to do in pain management, but are now left wondering what they should do.
Dean said he felt that severe pain wasn’t a problem primary care doctors should be handling anyway, asserting that anyone with severe pain should see a pain specialist at least once. Dr. Thompson said that the pain specialty infrastructure in Vermont was inadequate to handle the caseload that would result if everyone with severe pain had to see a specialist to get good pain management. Several other VMS members agreed that providing high quality pain care was an important part of primary practice.
http://www.vtmd.org/LEG&POL/pol-bull020102.htmlAnd Vermonters who get help paying for drugs under the Vermont Health Access Plan, or VHAP Pharmacy, which covers all drugs and requires only a $1 or $2 co-payment, would also have to pay half the cost with a $750 limit.
All Medicaid patients would see some benefits curtailed because the state would no longer pay for dentures, chiropractic, or podiatry services, and would limit prescription drug choices more severely.
Dean’s plan would also lower the amount the state pays to hospitals for treating Medicaid patients, rolling back an effort by the Legislature last year to beef up the reimbursement level and reduce “cost-shifting.
http://timesargus.nybor.com/Legislature/Story/41169.htmlWhile legislators argue over which services to cut, the truth is that there is plenty of money to fund all needed programs. Two examples: By instituting a more progressive tax structure, like the "Snelling" tax of 1990 which taxed the wealthy at higher rates, the state itself has estimated that $130 million would be raised in 2002. In addition, by taxing stock market profits and other capital gains at the same rate as wages -- wages are currently taxed at a higher rate -- more than $25 million more would be available.
Because most new sources of revenue won't be available until next year, the state can and should use the Rainy Day Fund now. Only half of this fund is needed to reverse all cuts for this year. As recently reported, many other states are turning to the Rainy Day Fund to make it through the recession (Burlington Free Press, Feb. 5).
Do proposals like the ones described above place an unfair burden on the rich? Consider that for the past decade, the wealthy have benefited from tax cuts and preferential treatment for stocks and other unearned income while regular Vermonters have seen their real wages go down. For example, when the tax rate was decreased from 25 percent to 24 percent of the federal rate in 1999, the top 9 percent of Vermont households received over half of the $15 million in lost state revenue. This budget "crisis" didn't just happen -- the state spent the past decade giving away its surplus instead of planning for harder times. To balance the budget on the backs of families already suffering from the current recession, when the state has the option of using the Rainy Day Fund and raising revenue through fairer taxation, is inexcusable. Vermonters have the right to expect better leadership than that. There is no question that reversing the cuts and fully funding public programs is both feasible and necessary. The only question is whether or not legislators will choose to protect the economic security of all Vermonters.
http://www.vtlivablewage.org/vwc/docs/tenaya_oped.htmlOne thing to remember, Dean didnt get ALL of the cuts he proposed. The legislature over-rode him, and added money back into the busget to replace items Dean cut.
Other states, like Vermont, fear the
economy may worsen before it improves,
and are reluctant to use their rainy day
funds at all. "It's only drizzling," Vermont's
Senate Appropriations Chairwoman Susan
Bartlett told the
Vermont Press Bureau
.
"Prudent fiscal management means looking
ahead and being prepared." Instead of using
reserves, Gov. Howard Dean has proposed
rolling back Medicaid benefits and increasing co-payments,
or a savings of $16.5 million. The cuts would effect only
those who do not meet federal income eligibility require-
ments for the program. Dean stressed that no child would lose
coverage under his plan, and that the reduced benefits would
only effect services outside the basic coverage plan, like
podiatry and dental care.
Some policymakers have expressed concern that dipping
into their rainy day fund could hurt their state's bond rating.
That would be unlikely, according to analysis from Standard
and Poor's. In an October 2001 report, the firm said that a
"balanced approach of adjusting spending and drawing on
reserves will reduce out-year structural imbalance" and prob-
ably not lead to a downgraded bond rating.
"Sin Taxes"
In addition to using rainy day funds and making tough
spending cuts, states are increasingly looking to generate rev-
enue from "sin taxes.
http://216.239.37.104/search?q=cache:AbsqkiPzrhEJ:www.csgeast.org/Publications/Winter%2702%2520FINAL.pdf+%22Howard+Dean%27+%22Vermont%22+%22Budget+Cuts%22+%22Health+Care%22+Dental+Care&hl=en&ie=UTF-8Dean did not want to cut dentures but all dental care.
Deanís budget recommendation would eliminate a Medicaid prescription drug assistance plan for elderly, disabled and uninsured adults of all ages and require significant cost sharing for recipients of other state health assistance programs. The Governor and many Democrats support raising the tobacco tax 67 cents to avoid these benefit reductions and discourage young Vermonters from taking up smoking. Deanís proposal would also eliminate free adult dentures, chiropractic care, podiatry and other Medicaid dental programs.
http://www.bcbsvt.com/isreply/isrep-3-2002.htmBut along with this. He recommended incresing the 2 dollar per visit co-payment per doctors visit, Creating a 25 dollar per visit emergency room fee, which did not exist before this. As well as greatly increasing the amount that the elderely paid for their prescription drugs.
Since charity was fairly on the money for the other services, I doubt she was wrong about the eyeglasses.
And Deans cutting of coverage for the handicapped, disabled, blinf, and poor was nothing new. The legislature had to battle him over this from the day he became governor.
Again, the Dr Dynsaur program is not state finded. Dean moved the program over to Medicaid in 1992, so it is NOT separate from medicaid, and is funded under the same ssystem that is called KidCare in other states so it is now a federally funded program in which the state must match 40 percent to the federal 60 percent:
In 1989, Vermont created the Dr. Dynasaur program, which provided state-funded health assistance to children six years and younger, as well as pregnant women who did not qualify for Medicaid up to 200 percent FPL. By 1992, the program had expanded to cover children up to age 17, up to 225 percent FPL, and was integrated into the state Medicaid program. This was later expanded under the CHIP program to cover children up to 300 percent FPL. In 1991, Vermont passed the Act 160 Legislative Initiatives, which required all insurers with small-employer products (50 or fewer workers) to guarantee-issue policies at community rates and committed the state to the goal of universal health insurance coverage. The Vermont Health Access Program (VHAP) was designed to operate under a 1115 Medicaid waiver. The waiver was granted in 1995 and recently extended to ensure that it would remain operational until at least 2003.
VHAP covers custodial parents and caretaker relatives up to 185 percent FPL, noncustodial parents and other adults up to 150 percent FPL, aged and disabled through 105 percent FPL, and pregnant women through 200 percent FPL. The VHAP Pharmacy Program replaced the V-Script program, initially started in 1989. The programs were initially designed to provide pharmaceuticals to low-income elderly citizens. It has been expanded to cover Medicare beneficiaries up to 175 percent FPL and other individuals with incomes up to 300 percent FPL. Existing Major Access Programs Dr. Dynasaur, VHAP, Medicaid SPG FINDINGS Insurance DataAbout 51,390 (8.4 percent) of Vermont’s 608,829 citizens lack health coverage. The uninsured include people at all income levels; 21.6 percent of the uninsured had incomes below FPL; 29.6 percent had incomes 100–200 percent FPL; 22.3 percent had incomes 200–300 percent FPL; and 26.3 percent had incomes greater than 300 percent FPL. More than three-quarters of the uninsured population were employed; 66.5 percent of the uninsured were working full time and 10.5 percent were working 30 hours or less per week. Most Vermonters believe that the government and employers should be responsible for providing health insurance, although they were wary of a government-only system, such as a single-payer model. Tax credits, subsidies, or other incentives to health insurance elicited concern about “red tape,” complicated applications, and inflexible eligibility standards. There was also little support for a low-cost insurance option.
Interim Final Report
http://www.statecoverage.net/statereports/vt.pdf March 15, 2002. Final Report
http://www.statecoverage.net/statereports/vt7.pdf http://216.239.39.104/search?q=cache:6xtlBGAOlUAJ:www.statecoverage.net/statereports/vt11.pdf+%22Vermont%22+%22HRSA%22+%22%22Act+160%22&hl=en&ie=UTF-8This problem is, to maintain the Dynasaur program at the levels Dean wished, he had to slice all of those benefits noted from poor adults. Which eventually Dean may have to answer for, as it is was likely illegal. Particularly the changes to the prescription drug benefits.
Sorry, you guys keep slinging that childrens prrogram lie about a state funded program like it is something special Dean created. Again, it is plain old medicaid and this is part of the HRSA application for federal grant money and request for extension of the subsection 1115 exemption Deansed to take money from otherederal programs to fund it. Dr Dynsaur stated out as a Vermont STATE program and Dean turned it into plain old medicaid.
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