[B]URLINGTON — Vermont’s five leading candidates for governor agreed that community mental health organizations and home health agencies are good for the state and should be fully funded.
They overwhelmingly agreed that the state has not achieved parity between mental health and physical health, and they largely agreed that Vermont is relying too much on incarceration for people with mental health and substance abuse issues.
The five spoke at a forum on community health and support services that was hosted by the Vermont Association for Mental Health and Addiction Recovery. The three Democrats and two Republicans largely supported community efforts, but their policy differences were in the details.
Candidates differed over what to do about Vermont Health Connect, whether to revive single-payer health care and how to handle the proposed all-payer model. The state’s ongoing challenge in which mental health patients are held in emergency rooms for days before being placed in a psychiatric hospital received little scrutiny.
“I think the challenge is, we don’t know until they get to office,” said Julie Tessler, the executive director of the Vermont Council of Developmental and Mental Health Services, which co-sponsored the forum. “Will they find a way to set the priorities?”
“It’d be great to see some plans for action and how they’re going to fund it, and just how that works for health care,” Tessler said. “I think most of them get the message that it’s about investing in community- and home-based services and that it can pay for itself.”
Peter Galbraith, a Democrat, was the single candidate who said he would raise taxes to fund what he called “essential public services.” In response to almost every question during the 90-minute forum, Galbraith brought up a new special interest tax loophole that he said he would eliminate as governor to raise revenue.
Lt. Gov. Phil Scott, who is running for the Republican nomination, said there is no more taxing capacity within the state and he would instead seek to find efficiencies in government spending. He said the state may be able to reallocate some of the administrative costs of running Vermont’s Medicaid program.
Democrat Matt Dunne said there is plenty of money in Vermont’s health care system but that current payment methodology does not promote public health. He advocated for payment reform to fund community services but stopped short of endorsing the proposed all-payer model that the Green Mountain Care Board and the Shumlin administration have been negotiating with federal officials.
Sue Minter, a Democrat, said plainly that she would increase funding for community health services, but she did not outline a particular source of revenue. She endorsed the proposed all-payer model as a way to reallocate money and pointed to a case of a homeless man with diabetes who could be better served through housing and community health care than a hospital.
Republican Bruce Lisman said he would save money for the state because he would abandon Vermont Health Connect and move to the federal exchange. He said there are inefficiencies in health care costs, which he said are not increasing as fast as insurance premiums. He said designated mental health agencies need a dedicated funding source, and he called for “caution” on the proposed all-payer model.
Each candidate’s positions
Galbraith and Dunne were the only two Democrats who said they would support a gradual move to a single-payer health care system. Galbraith said he would fund universal primary care with a 2 percent payroll tax. Dunne said he wanted to use payment reform as a jumping off point for quickly moving to universal primary care health care “so that everyone gets a doctor.”
Minter’s health care priorities most closely aligned with outgoing Gov. Peter Shumlin’s. Minter called the deal with the federal government to set up an all-payer model a matter of “when.” She said the system would prioritize community health and could penalize hospitals if their emergency room patients are readmitted to the hospital within a short time.
Lisman was the only candidate who said he would fully abandon Vermont Health Connect and move to the federal exchange. Scott said he would like to partner with Connecticut to set up a regional exchange. Dunne said repeatedly he would “fix the damn website,” and Minter said, less colorfully, that she wanted to fix it.
Lisman and Dunne said Vermont should stop sending inmates to private prisons; Minter said money should be spent on treatment and education instead of incarceration; Galbraith said his plan for free college tuition is cheaper on a per-person basis than prison; and Scott paraphrased a quote from Shumlin, who said society often locks up people it doesn’t understand.
In response to a question about a continuous bottleneck of psychiatric patients waiting in emergency rooms before getting to appropriate psychiatric hospitals, Minter called for more beds in the state’s psychiatric system. “We clearly don’t have enough beds for the acutely mentally ill,” she said.
Scott said the state needs to provide more outreach services for people with mental health needs before they get to the ER. Dunne said the bottleneck is an example of how the health care system pays for services in the wrong place.
Galbraith said the ER bottleneck is an example of a health care system that is “off-balance,” and he pointed to hospital executives who are making million-dollar salaries. Lisman cited his proposal to audit Medicaid to better understand people’s needs.
Minter said domestic violence is a public health issue in Vermont similar to opiate abuse.
A quote from each candidate
• Galbraith, on Scott’s view that Vermont needs a population of 700,000: “I’m not going to promise to increase the state’s population because I’ve done my own little part. … I have three kids.”
• Dunne, on efforts to make mental health care equal to physical health care: “Anyone who thinks we have reached mental health parity, please raise your hand.”
• Lisman, on how his management style would be different from Shumlin’s: “I think we need to hire the best people we can find and not the best people we know.”
• Scott, on the future of health care reform: “Health care reform never ends. It just continually evolves. And I think it’s something that we’re going to keep working on until the end of time.”
• Minter, on whether she can negotiate with federal health care regulators: “Let me tell you that the Federal Highway Administration and FEMA are just as difficult” as the Centers for Medicare and Medicaid Services.