by Mike Smith The Vermont Agency of Human Services (AHS) was created in 1970 in an effort to unite various human services departments under a single leadership structure. The goal was to create an organizational structure that would deliver services to Vermonters in a more coordinated manner.
Currently the agency consists of the departments for Children and Families (DCF), Corrections, Vermont Health Access (DVHA), Disabilities, Aging and Independent Living (DAIL), Health, and Mental Health. It is an enormous agency – the largest in state government with thousands of employees – that constitutes nearly half of all state spending.
The Vermont Senate is advancing a proposal to separate the health care functions currently within the Agency of Human Services into a new agency called the Agency of Health Care Administration. It would be comprised of entities that would operate Medicaid services; mental health and substance abuse programs; long-term care for the elderly and disabled; and public health functions. It would also include the state’s troubled health care exchange—Vermont Health Connect.
Senate appropriations committee chair Jane Kitchell, herself a former Human Services secretary, supports this change. The Senate Government Operations Committee has unanimously passed this proposal out of its committee. Even Senate President Pro Tempore John Campbell has voiced support for human services to be reorganized.
The main reason they support this reorganization, advocates say, is that the growth of health care has diverted attention away from the agency’s other functions, such as prisons or child safety. It is true that there are real and significant challenges within the Agency of Human Services. But the critical question is this: Is the growth in health care to blame for these challenges or are the issues more systemic?
The Shumlin administration has voiced opposition to this reorganization. Human Services Secretary Hal Cohen opposes splitting into separate agencies because it makes more sense to keep all these services together to allow for greater integration and coordination among services.
Secretary Cohen makes a strong case against this legislative proposal.
In the private sector this would be the equivalent of splitting up Apple Corp. because their attention is diverted to iPhones instead of iPads or iMac computers. Apple shareholders and management expect a single, efficient entity to be able to handle all core functions. And the expectations should be the same for the Agency of Human Services.
Instead of creating more costly and cumbersome bureaucracies that taxpayers cannot afford nor understand, the drive should be toward creating a more efficient agency. Social problems are complex and require comprehensive solutions, often involving multiple human service departments, including those associated with health care. The solution to addressing drug and alcohol addiction, domestic violence, lack of education, access to mental health care and adequate housing, as well as multi-generational poverty and inadequate employment opportunities and a host of other difficulties should not be in further fragmenting our efforts. Instead, the opposite should happen – if any change is to be made then efforts should be directed toward further integration. Bureaucratic compartmentalization won’t work and it will be a roadblock to meaningful solutions to these complex problems. We’ve all had maddening experiences trying to navigate state government. Imagine the experience of someone with complex needs managing an even more complicated bureaucracy.
There is no doubt that state government’s health care systems are challenged, even dysfunctional in some areas. But the solution to that problem will not be found in creating more bureaucracy, when we should be creating less. We should be breaking down barriers so it’s easier for our dedicated state workforce to solve problems, for managers to determine where we need to make a change and for the Legislature to measure outcomes for the taxpayers footing the bill.
One idea is to put more responsibility for the delivery of services in the hands of the district offices. Further centralizing an already top-heavy system will not produce the desired results. Centralization is an old – and increasingly expensive – way of thinking about government.
And it’s not just about money. What about the generations of Vermonters who live in this system without adequate support to move towards independence? We must do better by them.
Perhaps our problems don’t originate with the organizational structure. Maybe it’s really with some of the leaders who are running these programs. In the end this may be more about competence than an organizational structure.
Mike Smith was the secretary of administration and secretary of human services under former Gov. Jim Douglas. He is the host of the radio program,“Open Mike with Mike Smith,” on WDEV 550 AM and 96.1, 96.5 and 101.9 FM. He is also a political analyst for WCAX-TV and WVMT radio and is a regular contributor to the Times Argus, Rutland Herald and Vermont Business Magazine.