ERC region costly for Long Term Services and Supports while demand grows

Like the rest of the nation, the average age of CSG/ERC state residents is rising, driving up demand for long term services and supports (LTSS) such as home health and long term facility care. A new survey by Genworth Financial finds that costs for those services are high and rising. Nationally last year median costs for adult day care rose 5.9%, for assisted living facility care by 2.9% and the cost of a private room in a nursing home was up 4.2%. Unfortunately those costs tend to be much higher in the ERC region than the rest of the country. As Medicaid is the primary payer of LTSS services for people needing assistance with daily self-care, these costs will fall on state budgets. Genworth’s website allows searches for LTSS costs across home, community and facility settings by state or cities as well as a calculator that estimates the future costs of care for your local area.

Median annual costs of care Adult Day Care Assisted Living Facility Nursing Home (semi private room) Nursing Home (private room)
Connecticut $20,150 $66,900 $146,000 $158,775
Delaware $17,995 $68,940 $109,500 $117,895
Maine $28,080 $57,600 $100,375 $107,675
Maryland $20,540 $46,800 $101,379 $110,230
Massachusetts $16,900 $63,600 $128,845 $139,580
New Hampshire $16,900 $61,230 $115,340 $122,275
New Jersey $22,165 $68,700 $116,800 $127,750
New York $22,100 $49,200 $131,758 $136,437
Pennsylvania $15,600 $42,660 $105,485 $113,150
Rhode Island $17,290 $63,900 $93,075 $103,113
Vermont $32,136 $48,240 $102,018 $105,120
US average $17,904 $43,200 $80,300 $91,250

CSG/ERC region scores well in health care quality, but significant disparity challenges

The latest National Healthcare Quality and Disparities Report from HHS finds significant improvement in access to health care across groups in 2014, likely due to the Affordable Care Act. Released earlier this month, the annual report tracks over 250 measures of quality and disparities in health care. ERC states generally performed better than the nation on quality measures but varied considerably in eliminating disparities. Among ERC states, only Maine performed among the best in both categories. Americans’ quality of care has improved across most metrics. Improvement in patient safety was remarkable with 17% fewer hospital-acquired conditions saving an estimated $12 billion. However few disparities were eliminated; poor Americans continue to experience less access to care and poorer quality. Two bright spots were the elimination of disparities in some childhood immunization rates and rates of adverse events. However some disparities in hospice care and chronic disease management got worse. Challenges remain. Click here for the report chartbooks, here for the State Snapshot Tool and here to spend some time Mapping Medicare Disparities by state or county and by condition, year, sex, age, and race. Warning – it is very easy to spend an entire afternoon in the data without realizing it.

 

Quartile for quality performance

First = highest quality

Quartile for disparities performance

First = fewest disparities

Connecticut First Second
Delaware First Fourth
Maine First First
Maryland Third Second
Massachusetts First Fourth
New Hampshire First Third
New Jersey Second Fourth
New York Second Fourth
Pennsylvania Second Third
Rhode Island First Fourth
Vermont First Second

Supreme Court rules against VT health price database

For many years, health care prices paid by US insurers and employers have been protected as trade secrets. Those prices and the lack of transparency are widely blamed for the high costs of health care in the US. To address this problem most states, including all ERC states, are creating all-payer claims databases (APCDs) as critical tools to support health system reform efforts. Ideally APCDs include detailed claims data from every coverage plan in a state allowing comprehensive health care delivery planning, public health interventions, “hotspotting” health care problems, program evaluation, and fair payment rate setting among many benefits. An APCD can also be used by consumers and payers for price shopping, which may help control health care costs.

 

However earlier this month, in Gobeille v. Liberty Mutual, the US Supreme Court ruled that under federal law self-insured plans, covering 63% of Americans, do not have to submit their data to Vermont’s APCD. Seventeen states and the District of Columbia filed briefs supporting Vermont’s position including New York, Connecticut, Maine, Maryland, Massachusetts and Rhode Island. Large health systems and large insurers who tend to get better prices have the most to gain by the Court’s ruling. Potential solutions include Congressional action, although that is unlikely, or regulations from the federal Department of Labor.

Canada Pushes Airport Preclearance

Canada – U.S. Border Update                                                March 2016

Canada Pushes Airport Preclearance

The new Liberal government in Ottawa is making a renewed effort to increase
customs preclearance capabilities for persons traveling by air to the U.S.
Transport Minister Marc Garneau was recently in Washington to talk to U.S.
officials about the prospect of adding Toronto and Quebec City airports to the list
of Canadian airports that have U.S. Customs officials working onsite.
Canadian federal and provincial officials believe that expanding U.S.
preclearance capability to the Billy Bishop airport in Toronto and the Jean
Lesage airport in Quebec City would increase the availability of direct flights to
more destinations in the U.S.

Many small and mid-size U.S. airports do not have customs facilities on site,
meaning international travelers must route through an airport that does.
Eight Canadian airports already offer U.S. Customs preclearance: Ottawa,
Toronto Pearson, Vancouver, Calgary, Edmonton, Halifax, Montreal and
Winnipeg. According to U.S. Customs and Border Protection, operations at
these airports preclear approximately 11 million passengers bound for the U.S.
each year.
Last year the Canadian and U.S. governments reached an agreement in
principal to broadly expand preclearance and pre-inspection of passengers and
cargo on each other’s soil. The agreement covers all transport modes; land, air,
rail and marine.
However, the pact requires approval by the national legislatures of both
countries; something which has not yet happened.
CSG/ERC has long been an advocate for expansion of preclearance programs
and has strongly urged the two countries to move quickly to remove remaining
barriers.

MacNaughton named Ambassador to the U.S.

David MacNaughton has been named Canada’s new Ambassador to the U.S.
He takes over from Gary Doer (See accompanying article).
MacNaughton is a business executive and public affairs consultant who has
been active in Liberal Party politics. Most recently he has served as Chairman of
StrategyCorp, a Toronto-based consulting firm.
A confidant of new Prime Minister Justin Trudeau, MacNaughton served as
Ontario co-chair for the Liberal Party’s national political campaign last year.
In a statement released to the press, MacNaughton said “I’m honoured to
become Canada’s diplomatic representative with our most important economic
and national security partner… The relationship between Canada and the United
States is as important today as it has ever been. I look forward to serving Prime
Minister Trudeau, the Government of Canada, and the Canadian people to
ensure we expand and deepen our productive and constructive relationship with
our closest ally and neighbour.”
Doer Joins Can/Am BTA Advisory Board
Former Canadian Ambassador to the U.S. Gary Doer has joined the Senior
Advisory Board of the Canadian/American Border Trade Alliance (Can/Am BTA).
Can/Am BTA President & CEO James D. Phillips released a statement saying
the organization has “enjoyed a long standing and productive working
relationship with Ambassador Doer and we look forward to his effective
presence.”
Can/Am BTA is a group of private and public sector organizations working to
facilitate cross-border movement of people and goods.
Doer also recently announced he will take up a part time position with the
Woodrow Wilson Center, a Washington D.C. – based think tank. Doer will cochair
the advisory committee to the Center’s Canada Institute which focuses on
Canada-U.S. relations and Canada’s international role.
Doer was appointed to his diplomatic post by former Prime Minister Stephen
Harper in 2009. He left office last month to make way for David MacNaughton;
new Prime Minister Justin Trudeau’s selection to replace him (See
accompanying article.)
Prior to being named ambassador in 2009, Doer was Premier of Manitoba.

For more information, please contact Earl Eisenhart
The Council of State Governments Eastern Regional Conference
22 Cortlandt Street
New York, New York 10007
212-482-2320

Transportation Report — March 14

Week of March 14, 2016
“Orphaned” Funds Available
Recent new guidance from the Federal Highway Administration (FHWA) announced that roughly $2 billion in previously unused earmarks can be put back to work to support infrastructure projects across the country. As previously reported, the guidance implements a provision in the Consolidated Appropriations Act 2016, which gave states the option of repurposing certain earmarked funds if the original earmark was over 10 years old, and if less than 10 percent of project funds had been obligated, or if the project is closed. Through the end of FY 2016, states have the option of re-designating these dollars to other projects within 50 miles of the originally intended use.
FHWA’s list of potentially eligible old earmarks meeting the under 10% obligation requirement totals $1.96 billion. A list of earmarks that may be eligible for repurposing is available here http://www.fhwa.dot.gov/cfo/earmarkrepurposing.
Here’s a quick first look around ERC:
ALLOCATED EARMARK PROJECTS STATUS FOR FUNDS AVAILABLE IN FMIS DEMO by STATE or TERRITORY LESS THAN 10% OBLIGATED,
As of December 18, 2015
(Millions of US $)
Connecticut        $81.388
Delaware               $4.169
Maine                     $7.696
Maryland               $23.682
Massachusetts      $93.346
New Hampshire    $7.531
New Jersey         $115.979
New York*          $207.218
Pennsylvania       $98.724
Puerto Rico          $14.785
Rhode Island         $3.121
Vermont                  $1.906
* New York has the largest amount of potential repurposed funds nationally.
http://www.fhwa.dot.gov/cfo/earmarkrepurposing/allocated_earmarks_lessthan10percent_erp.pdf

The March 8th action also builds on a similar action in August 2012, when USDOT made over $470 million in unspent earmarks immediately available to states for projects that create jobs and help improve transportation across the country.
We hope you’ll mark your calendars to attend the 56th CSG/ERC Annual Meeting which will be held from
August 7-10, 2016 in Quebec City, Quebec, Canada.
For more transportation policy committee activities contact:
CSG|ERC Transportation Policy Co-consultants:
Steve Hewitt, shewitt109@aol.com or Don Hannon, DonHannon@iCloud.com
22 Cortlandt Street | 22nd Floor | New York, NY 10007 | p. (212) 482-2320 | f. (212) 482-2344
Transportation Policy Newsletter March 18, 2016
“Keeping our Members informed”

Transportation Funding

On February 23, The Council of State Governments hosted a webinar on transportation funding, moderated by Sean Sloan, director of transportation and infrastructure policy for CSG.  The speakers included Joe McAndrew, policy director of Transportation for America, Alison Primo Black, Senior Vice President and Chief Economist of the American Road and Transportation Builders Association, and several journalists. According to Black, there were 179 transportation funding bills introduced in 2015 nationally. Eight states passed gas tax increases.  Other bills included user fees, such as automobile registrations and tolls and lock-boxes. Among the trends in transportation, governors are playing a key role in championing this legislation and there are broad based coalitions of public and private partnerships. Transportation funding gets bi-partisan support with lots of backing at the county and local level. Over the past 10 years, 72 percent of ballot measures have passed. “People are willing to invest in transportation,” she said.

Transportation infrastructure investment was mentioned as a top priority by most of the northeastern governors in their State of the State addresses. Among them was Maryland Gov. Larry Hogan, who reported a $2-billion investment in “shovel ready” infrastructure projects to fix bridges and roads. Massachusetts Gov. Charles D. Baker said the state was doubling the capital investment in transportation to $1 billion, including a major investment in mass transit in the city of Boston. In New York, Gov. Andrew Cuomo’s ‘Built to Lead’ program proposed a $100 billion investment in transportation infrastructure, including New York City’s commuter transportation system, the MTA, the New York Thruway and upstate airports, bridges and roads. Throughout the region, urban mass transit is getting more focus as a means to revitalize communities and serve changing demographic needs.  Ongoing state committee hearings, executive and legislative research efforts, and transportation funding advocates are discussing how best to address the transportation infrastructure funding shortfalls.

In Rhode Island, Gov. Gina Raimondo on February 11 signed   Bill 2246/ House Bill 7409, otherwise known as “RhodeWorks”, which will charge a user fee on large commercial trucks in order to repair and maintain the state’s bridges. The state will also leverage $300 million in federal GARVEE bonds. GARVEE is an acronym for a grant anticipated revenue vehicle, which is a debt financing instrument for state highways. The legislation will increase transportation funding by $1.1 billion over the next 10 years, including an estimated $45 million per year in tolls.

The trucking industry opposed the bill, said Keith Goble, state legislative editor for Land Line magazine during the CSG webinar. He added that in a survey of 400 truckers “three quarters will avoid Rhode Island if the state adopts truck only tolls.”

In Massachusetts, would authorize cities and counties to create special transportation finance districts, which would be given the ability to levy an additional local property tax in order to generate revenue for transportation projects (in conjunction with the Massachusetts Department of Transportation and the MBTA).

In Connecticut, Gov. Dannel P. Malloy has proposed a 30-year, $100-billion program, according to Chris Keating, Capital Bureau Chief for the Hartford Courant, who also presented at the CSG webinar. For the most part, the plan is still in its infancy, but the widening of I84 has already begun. The funding would come from a combination of tolls, taxes and bonding. Twenty-four percent of the tolls would be paid by heavy trucks and 30 percent by out-of-state drivers. The plan also includes an increase in the 25 cent gas tax, by 2 cents per year for seven years.

Spotlight on Bridges

The Federal Transportation Department estimated a $115 billion backlog in repairs for bridges rated structurally deficient or functionally obsolete nationally.

According to the American Road and Transportation Builders Association, nearly ten percent of the country’s bridges – 58,495 out of 609,539 – were considered structurally deficient last year and needed repairs. This is 2,574 fewer bridges than the more than 61,000 in 2014 that needed repairs, so some progress has been made.

Among the five states with the biggest share of deficient bridges were Rhode Island at 23.2% and Pennsylvania at 21%,

The 250 most heavily traveled bridges that need repairs include:

— In Pennsylvania, several Interstate 95 bridges in Philadelphia.

— In Maryland, several Interstate 95 bridges.

— In New York, the Brooklyn Bridge.

 

 

 

Important Developments in Puerto Rico’s Transportation System

On February 25th US DOT Secretary Foxx made an historic trip to San Juan, Puerto Rico with Federal Highway Administrator Gregory Nadeau to join Governor Alejandro Javier García Padilla and Puerto Rico Secretary of Transportation and Public Works Miguel Torres Díaz in signing an agreement that further strengthens the development of transportation infrastructure and promotes economic recovery in the Commonwealth.
This agreement provides federal technical assistance to ensure that Puerto Rican transportation officials are able to expeditiously access about $400 million in previously obligated federal funds for infrastructure projects that will create jobs and spur economic development. It also represents an important step in Puerto Rico’s plan to improve its billing procedures by increasing capacity for developing and sustaining best practices, such as using electronic funds transfer and reducing the time it takes to pay contractors.
Under the new agreement the Puerto Rico Highway and Transportation Authority (PRHTA) would complete the billing process more expeditiously, as the federal government would now pay contractors directly, rather than having the PRHTA pay them and then wait to get reimbursed.
Further, the agreement permits the Federal Highway Administration (FHWA) to authorize the retroactive use of toll credits to be used for state matches, allowing PRHTA to maximize their access to federal funding. This will allow Puerto Rico to use roughly $756 million in toll credits that hadn’t been claimed in years by the commonwealth government. Under the Memorandum of Understanding (MOU), Puerto Rico will now be allowed to use these toll credits retroactively, but only to cover what the Commonwealth needs to match funding for existing projects.
Other CSG-ERC states regularly use toll credits to provide the match for highway and transit projects. Advocates have urged the use of toll credits for intercity passenger rail capital projects.

We hope you’ll mark your calendars to attend the 56th CSG/ERC Annual Meeting which will be held from August 7-10, 2016 in Quebec City, Quebec, Canada.
For more transportation policy committee activities contact:
CSG|ERC Transportation Policy Co-consultants:
Steve Hewitt, shewitt109@aol.com or Don Hannon, DonHannon@iCloud.com
22 Cortlandt Street | 22nd Floor | New York, NY 10007 | p. (212) 482-2320 | f. (212) 482-2344
Transportation Policy Newsletter March 4, 2016
“Keeping our Members informed”

EPA’s Clean Power Plan: A Brief Overview for the ERC Region

Clean Power Plan

On August 3, the Obama administration finalized the Clean Power Plan, the first-ever national rule to cut carbon pollution from existing power plants. The U.S. Environmental Protection Agency (EPA) also issued final carbon pollution standards for new, modified, and reconstructed power plants, and proposed a federal plan and model trading rules to assist states in implementing the Clean Power Plan. In announcing the plan at the White House, President Obama called it “the single most important st

ep America has ever taken in the fight against global climate change.”

The final rule was developed under Section 111 (d) of the Clean Air Act, and includes a number of modifications to the draft rule released two years ago, which received more than four million comments from state and federal officials, utilities, energy producers, nongovernmental organizations and others. It calls for a 32 percent reduction in carbon pollution from existing power plants by 2030, based on 2005 levels, and assigns each state a specific emission-reduction goal based on that state’s energy mix. EPA will provide guidance to states but leaves much of the design for the emissions reductions to them. The agency anticipates that allowing states the flexibility to devise cost-effective plans to meet their targets will help lower costs to consumers, and spur private investments in renewable energy and energy efficiency technologies. States have until 2016 to craft a draft plan for complying and until 2018 to submit a final plan.

States can use EPA’s model trading rules or create their own plan to achieve the required cuts. States have significant leeway to develop and implement plans that ensure that the power plants in their state – either individually, together or in combination with other measures – achieve carbon-dioxide (CO2) emissions performance rates over the interim compliance period, from 2022 to 2029, and the final emission performance rates, rate‐based goals or mass‐based goals by 2030.

The final rule also gives states the option of working with other states on multi‐state approaches to address carbon pollution.

Fossil fuel-fired power plants represent roughly one-third of CO2 emissions in the U.S., the largest source of such pollution. EPA projects the rule will lead to a dramatic decline in other harmful pollutants as well, and benefit public health. Emissions of soot- and smog-forming sulfur dioxide are expected to drop by 90 percent, and nitrogen oxides, by 72 percent. The agency calculates the rule will produce net climate and health benefits totaling $26 billion to $45 billion, and avoid 3,600 premature deaths each year. It also projects that it will lower electric bills by $7 per month by 2030.

Continue reading on Green Matters

2016 State of the States

ERC_Web_Slide_Template-01

ERC governors talk about jobs, infrastructure, pension reform, opioid addiction and more…
The economy and jobs were the central focus of the 2016 State of the State speeches delivered by the governors of 11 ERC member states (from Maine to Maryland). While there was much talk about budget deficits, fiscal restraint and pension reform, jobs and job growth were seen as central to the states’ economic health. Education was also a major focus, as the governors made the connection between a well-educated, highly-trained workforce and life sustainable employment that brings economic prosperity to the state and its people. Other key themes addressed by the governors included the importance investing in transportation infrastructure, energy and policies to address climate change and the growing problem of opioid addiction.

Below is a brief summary of the individual governor’s speeches addressing some of these themes. Each summary includes a link to a complete transcript of the speech:

Connecticut – “Connecticut’s private sector has grown more than 80,000 jobs in the last 5 years,” said Gov. Dannel P. Malloy in his State of the State speech on February 3. Malloy spoke at length about living within one’s means and building a sustainable budget “based on what we can afford, not what we previously spent.” He added that “after decades of neglect, we are finally paying out pension obligations every year.” Additionally, the governor spoke of plans to “fix our broken transportation system.” He stated several accomplishments, including an increase in affordable housing, higher graduation rates and test scores, an end to veterans’ homelessness and a crime rate at a 48-year low.

Delaware – Governor Jack Markell said in his State of the State address on January 21 that “since the national economy has bottomed out, Delaware’s job growth of 13 percent has outpaced neighboring states, adding more than 50,000 jobs.” With an emphasis on workforce training, his address promoted the expansion of TechHire with a focus on IT training, a Pathways to Prosperity Initiative providing training in key industries, and Delaware Promise creating jobs in health care. The SEED and the Inspire scholarship programs have provided scholarships to nearly 20,000 residents over the past decade to attend Delaware State University, Delaware Technical and Community College, and the University of Delaware. Other major issues for the state was the accelerating cost of health care, improving education, public safety and criminal justice, race relations, unplanned pregnancies, and the opioid addiction crisis.

Maine – “Mainers are dying every day from the drug crisis,” said Gov. Paul R. LePage in his address on February 8. He suggested a multi-pronged approach involving law enforcement, treatment and education. The statistics include 231 overdose deaths, 265 heroin related arrests, and 1,013 affected births. The governor’s other proposals included welfare reform, eliminating the state income tax, and increasing the sales tax. In terms of energy, LePage is in favor of lowering electricity rates, expanding hydropower and natural gas and supporting the biomass industry with its emphasis on using wood, in lieu of renewables like wind and solar. Other issues addressed included the student loan crisis, and the major drug crisis afflicting the state.

Maryland – Governor Larry Hogan reported on a robust economy. Describing “a new era of bipartisanship,” in his address on February 3, the governor described the successes of a “more competitive and business friendly state” — $600 million in tax returns, the elimination of 100 fees, 55,000 new jobs in the last 12 months, $150 million in additional tax revenues and the elimination of nearly 90 percent of the $5.1 billion structural deficit. Other priorities included education, the environment and transportation education with investments in these areas — $180 million in K-12 education, a $53 million investment in the Chesapeake and Atlantic Coastal Bays Trust Fund, and $2 billion in “shovel ready” infrastructure projects.

Massachusetts — Gov. Charles D. Baker reported in his address on January 21 that the state “closed a $1-billion budget deficit without raising fees or taxes.” Transportation infrastructure was a critical need; the governor advocated doubling the capital investment in transportation to $1 billion, particularly for the Boston mass transit system. Education was another key priority, particularly the expansion of charter schools, with “37,000 …kids…on a waiting list.” In the area of renewable energy, in addition to a growing solar industry, the governor spoke of partnering with other New England states to increase the supply of “clean, affordable hydropower.” Opioid abuse was another challenge that the governor mentioned. In Massachusetts, four people die every day from a drug overdose, and doctors prescribe some 4 million prescriptions for opioids each year.

New Hampshire – Gov. Maggie Hassan reported in her State of the State address on February 4 that the state economy is strong. Fiscal 2015 ended with a $62-million surplus, doubling the state’s rainy day fund to its highest level since 2009. Revenues are already exceeding $40 million above projections. The unemployment rate has fallen to 3.1 percent, the lowest level in 16 years. The opioid addiction epidemic remains a pressing problem, with more than 400 overdose deaths last year, the second most common cause of death in the state. In response to the crisis, the state has streamlined access to treatment and strengthened its Prescription Drug Monitoring program. Other key areas include access to affordable health care, public safety, education, workforce development and clean energy.

New Jersey – Gov. Chris Christie cited strong economic recovery in New Jersey after “decades of bad governing.” Among the accomplishments that he mentioned in his address on January 12 were “224,000 new jobs in six years, recovery in home sales, and six consecutive balanced budgets with no new taxes.” Legislation to reform pension benefits generated a “$120-billion savings for taxpayers,” said Christie. He expressed concern over efforts to undo this legislation. Education was a top priority, with $12.8 billion in state funding for schools, reformed teacher tenure, and expanded charter schools. Other priorities include strengthening law enforcement and criminal justice reform. Christie cited a 52 percent drop in the murder rate in Camden. Mental health and drug addiction were also important issues, with opioid addiction reclassified as an illness and not a crime.

New York – Through a combination of spending and tax cuts, Gov. Mario Cuomo reported that the tax burden on New Yorkers was reduced by $114 billion in his address on January 13. His proposed ‘Built to Lead’ program projects a $100 billion investment in transportation infrastructure, including in New York City’s MTA, the New York Thruway and upstate airports, bridges and roads. In education, Gov. Cuomo proposed investments in SUNY and CUNY, K-12 and charter schools and universal Pre-K. Other priorities include entrepreneurial partnerships in agriculture, small business tax relief, environmental protection and renewable energy, public safety, anti-poverty programs, criminal justice, addressing housing and homelessness issues. The governor continued to push for and a $15 minimum wage. “The best social program is still a job,” said Cuomo.

Pennsylvania— Gov. Tom Wolf proposed that “every child in Pennsylvania has a world-class education that starts before kindergarten and goes all the way through college.” To that end, in his State of the State address on February 9 he proposed restoring the $1billion in education spending that had been cut by a previous administration. Wolf implored the legislature to pass the negotiated compromise budget so the administration can address the “ticking time bomb” of a $2-billion dollar budget deficit and a $17-billion debt. He notes that without addressing the serious budget crisis, the state will face “devastating” cuts in programs for technical education, children, seniors, the disabled and domestic violence survivors. “Our education system, already threadbare…will take a ruinous hit,” said Wolf.

Rhode Island– “Skills that matter, jobs that pay.” That was the focus of Gov. Gail Raimondo’s speech on February 2. Last year the state created 8,000 jobs “in a business climate that is easy to do business,” she said. Advocating for advanced industry high-wage jobs in areas like defense, IT and biomedical, Raimondo is proposing to expand the R&D tax credit, partner with colleges and universities, and provide programs for scholarships, workforce development and improved public schools. The governor advocated for an expanded earned income credit and a higher minimum wage. “No one who works full time should have to live in poverty,” she said. Other issues include addressing the public health crisis of addiction and overdosing. Rhode Island had 200 deaths from overdoses in 2014.

Vermont— In the past five years, Vermont added 17,600 new jobs, said Gov. Peter Shumlin in his 2016 State of the State address. By “being smart, not big,” the state added more than 100 manufacturing jobs though its Vermont Enterprise Fund and an additional 4,400 jobs in agriculture with the help of The Working Lands Fund, said Shumlin. Access to higher education for all Vermonters was a dominant theme. A proposed $2-million Step Up program would provide a free semester for first-generation and low-income students. Another priority was the environment. Vermont has more clean-energy jobs per capita than any other state, said Shumlin. He also called for passage of a clean water bill and the desire to divest from coal. The problem of opioid addiction was being addressed by a Prescription Monitoring System, partnering with neighboring states to prevent pill shopping.