Proposed state budget cuts for fiscal year 2019 would lead to layoffs at the Health Care Advocate’s office and the Green Mountain Care Board, spurring concerns about both agencies’ ability to fulfill their missions.
Chief Health Care Advocate Mike Fisher told the House Health Care Committee on Wednesday that a $110,833 reduction planned by Gov. Phil Scott’s administration would force him to eliminate 1.5 of his office’s seven advocate positions.
And Green Mountain Care Board Chairman Kevin Mullin said a proposed $754,719 reduction would cause the loss of three employees.
“People are going to be very busy, but it can be done,” said Mullin, a Scott appointee. “If you ask us to do additional work, it’s going to be tougher.”
Legislators were critical of the cuts and questioned their timing, given the state’s health care reform efforts and continuing turmoil at the federal level. House Health Care Committee Chairman Bill Lippert, D-Hinesburg, said lawmakers likely would seek to reverse at least some of the administration’s cuts.
“This is a proposal … and there’s whole budget process for the Legislature to go through,” Lippert said. “So we’ll see where we end up.”
Scott has pledged to curb the state’s spending growth, and his 2019 budget features no new taxes or fees. His proposed general fund spending is up just 2.3 percent from the current fiscal year.
But that fiscal discipline has resulted in cuts that could affect a variety of state services.
The health care advocate’s office, which assists individual Vermonters and also participates in state policy debates, is one example.
The advocate’s proposed budget cut actually comes via the Green Mountain Care Board, since the board supplies a portion of its funding. Mullin theorized that there would be fewer people requesting the advocate’s services because Vermont’s troubled health insurance exchange is now operating more smoothly.
Mullin said the advocate’s fiscal 2019 funding would be reduced to fiscal 2016 levels. “The exchange has less chaos, so we’re just going to roll it back to that pre-chaos level,” he said.
But Fisher argued that he can ill afford to lose staff “at a time when we continue to see … quite a lot of traffic to the advocate’s office.”
A recent report shows that the advocate is seeing fewer Vermont Health Connect-related cases, and the office’s overall call numbers were down in 2017. But Fisher said the office opened 945 cases in the past three months.
“These are Vermonters who are often at wit’s end, struggling with their providers, their insurance company or Vermont Health Connect, and who continue to need help accessing care,” he wrote in a budget summary submitted to lawmakers.
The office also has taken on work related to hospital budget reviews and the regulation of accountable care organizations; partnered with 22 pharmacies to assist those who have “needs that are too challenging for pharmacy staff”; and foresees more challenges related to federal policy changes.
While annual caseload numbers are down, “that doesn’t reflect the kind of flow that happens at peak times when we have a lot of people with urgent needs,” Fisher said.
After fielding numerous questions from committee members about the health advocate’s cut, Mullin threw the ball back into their court. “I think this is a legislative decision that you’re going to have to make on whether or not it was a correct decision,” he said.
Mullin also took time to detail how budget cuts would affect on his own agency. The care board has a broad mission that includes authority over accountable care organizations, hospital budgets, insurance rates and major expansion projects undertaken by health care providers.
Officials said the fiscal 2019 budget would eliminate three care board positions, including two staffers who handle rate review. “This is not something that’s comfortable for anybody, because these are good state employees,” Mullin said.
The lost staffers’ work would be spread among other care board employees, officials said.
Mullin, who was appointed to the care board last year by Scott, said he supports the governor’s proposed budget. He added that the care board had “specific instructions” to cut its spending.
“We’re always asking the hospitals and insurers to do more with less,” Mullin said. “I don’t think we’re immune to being asked to do more with less, either.”
Health Care Committee members were skeptical.
“The Green Mountain Care Board was created to help to slow the rate of growth of the largest sector of Vermont’s economy, and the part of Vermont’s economy that most Vermonters experience as the least affordable,” said Rep. Sarah Copeland-Hanzas, D-Bradford.
“At a time when we need the Green Mountain Care Board to be firing on all cylinders … it is really stunning to me that we expect you will be able to do that with fewer positions,” she added.
Lippert said lawmakers are “going to need to look at how to preserve the work of the Green Mountain Care Board.”
