[A] tri-partisan group of House lawmakers has introduced a bill that would publicly finance universal access to primary care services in Vermont.
The bill, H.207, would create a dedicated Universal Primary Care Fund within the Treasury to make capitated payments to health care providers that would cover primary care for all Vermont residents.
The legislation’s primary sponsor, Rep. Leigh Dakin, D-Chester, a member of the House Health Care Committee, is a career nurse who has worked in many different settings, from a hospital intensive care unit to an elementary school. The bill also has support from Rep. Anne Donahue, R-Northfield, ranking member on the Health Care Committee, and Rep. Sandy Haas, P-Rochester.
Dakin said her experience as a nurse convinced her that primary care is the “heart” of health care. She sees the bill as a way to take an incremental step toward Vermont’s goal of a unified and universal health care system.
The idea for the bill was floated by Deb Richter, a family medicine doctor and longtime advocate for universal health care. Richter said she wanted fill the policy “vacuum” created after Gov. Peter Shumlin decided not to pursue single-payer this year.
“The most important sector in health care is primary care, and it’s also inexpensive. It makes sense because everyone needs it,” Richter said.
Richter believes a universal primary care system will hold down costs because it will enable patients to better manage chronic conditions and avoid costly hospitalizations.
Under the proposal, Medicare and Medicaid would continue to pay first dollar for primary care services for their beneficiaries, but the new primary care program would cover any out-of-pocket expenses.
It would also eliminate all out-of-pocket costs for primary care services for people with private health insurance, and reduce premiums. The plan design of private insurance could remain the same, Richter said, but insurers would no longer need to pay out claims for primary care services. That would allow insurers to reduce premiums by as much as 8 percent, or the total amount of premiums that cover primary care, she said.
The bill defines primary care as “pediatrics, internal and family medicine, gynecology, primary mental health services, and other health care services commonly provided at federally qualified health centers.” It does not include dental care.
The portion of primary care not currently paid for by Medicare, Medicaid and private insurance would cost roughly $160 million, according to Richter’s “back of the napkin” calculation. The figure is based on a $500 per patient per year payment, which she says the average primary care physician would need to cover expenses and make a reasonable profit.
The bill requires the legislative Joint Fiscal office to calculate the exact costs of the program before Dec. 15, and identify possible revenue sources to pay for it. An appropriation to pay for it would then occur in “early fiscal year 2017,” according to the bill’s language.
H.207 also directs the Agency of Administration to begin negotiations with the federal Department of Health and Human Services by October to obtain a waiver to the Affordable Care Act that would allow the program to go forward, and explore the need for a Medicaid waiver as well.
The program’s anticipated launch date would be January 2017, the earliest states can obtain a waiver to the ACA.
Rep. George Till, D-Jericho, is an OB/GYN, and another of the bill’s sponsors. He said the bill piqued his interest because it would effectively move the state away from fee-for-service medicine in the primary care sector. Under the fee-for-service model, providers bill separately for each procedure or service.
Doing so has the potential to reduce emergency room visits, hospitalizations and referrals to specialists by allowing primary care practitioners to spend more time with patients and foster a greater focus on prevention, he said.
“It’s an interesting model,” Till said, and one he believes deserves greater attention.
But at the same time, Till questions whether Vermont has an adequate primary care workforce to meet the greater demand that more face-time with patients and more frequent wellness visits would create.
“We can’t fill (primary care) residencies nationally,” Till said, and Vermont could struggle to attract the workforce required to make universal primary care a success.
A companion bill in the Senate, S.88, introduced this week as well, is now before the Senate Health and Welfare Committee.
CORRECTION: Richter’s “back of the napkin” calculation of a total cost of $160 million is based on a $500 per patient per year payment, not a $500 per month payment as originally reported.
