Last week Governor Peter Shumlin presented his budget proposal to the legislature. After reading his speech and gathering media reports I almost started to think that perhaps he thought that Vermont had already passed a recreational marijuana law and that he had sampled the goods.
His judgment seemed clouded and some of his proposals appeared to have little basis in reality. Of course, the reality of a millionaire politician will always be quite different than the reality of most of the people he serves.
One of his more outrageous proposals was to cut the benefit eligibility threshold for pregnant women. In broad brush strokes he stated that, "To accomplish our vision, we are continuing to focus on the big things that will make the difference: Help families raise healthy children."
While he made that statement out of one side of his mouth he had set in motion a plan to decrease benefits for pregnant women in the Medicaid program and move their eligibility from 213 percent of the Federal Poverty Level to 138 percent. He backed off from that proposal within 24 hours, after pressure from more sensible Vermonters.
Many of Shumlin's proposals appear to give money to one group and then impose a tax on that group. A number of people I talked to find some of his recent budget proposals difficult to accept. They are counting the days until he vacates his office.
One group that he has really stirred up is independent practice doctors and dentists. He proposed that they pay a 2.35 percent provider tax in order to increase Medicaid reimbursement. Hospitals and nursing homes pay a similar tax at 6 percent and according to a Vermont Digger story, "The administration estimates the expanded provider tax would generate $17 million. The state would match the revenue with $20 million in federal Medicaid money to slightly increase how much the state pays doctors to treat low-income people."
It is possible I am missing something about this proposal but it sure looks like the same people who are paying a new tax would then receive an increase in state reimbursement for care when they provide care to Medicaid patients. I am not an accountant, but this sounds like a plan that low level criminals might cook up in order to try to fool people. Rob them in order to then give them some money to help them so they won't be too upset about being robbed.
The bigger question is why health care providers are being taxed in the first place. In Vermont they make much less than their counterparts in other parts of the country and they have resigned themselves to that. They make a good living, but they should not be targets for subsidizing health care reform, especially in a state like Vermont.
Piecemeal fixes such as taxes on providers only make it clearer how much of a dysfunctional health care system we have. We don't need a governor alienating the people who are trying to make the best of a broken system and we certainly don't need to ask providers to pay for the lack of political will to make much needed broader systemic changes.
The Digger story also pointed out Shumlin's duplicity in health care matters noting, "The tax proposal contradicts Shumlin's statement in December that he would not raise revenue and instead would "let brighter minds, I guess, try to figure that out." He also said in November that it would be "heartless" to sign people up for Medicaid and then "nibble away around the edges" at their benefits.
Shumlin's budget proposal is sure to stir up people from all points on the political spectrum. Maybe he thinks he has nothing to lose as a lame duck governor and that he can just throw out as many proposals as possible and see what sticks.
As he does so, more and more vulnerable Vermonters will suffer. His ideas will create new polarizing battles at a time when we all need to work together more effectively to solve some of the more pressing health care and social problems facing our state.