[H]ealth care advocates touted two pieces of legislation they see as a step toward universal publicly funded health care Saturday during a conference in Montpelier.
The identical bills introduced in the Vermont House and Senate earlier this year would make primary care available to all Vermonters by 2019.
Specifically, S.53 and H.248 identify their purpose as ensuring Vermonters are able to get primary health care “without facing financial barriers that would discourage them from seeking necessary care.”
Advocates for the bills see them as an incremental step toward universal publicly funded health care that could be palatable to a Legislature and electorate still remembering the failure of single payer.
In 2014 then-Gov. Peter Shumlin abandoned plans for a single-payer health care system because projected costs were considered prohibitive.
“I respect the fact that this was really difficult for the Legislature to consider suddenly a $2 billion tax which would double the state budget. … Try getting re-elected — it’s not that simple,” said Dr. Deb Richter, president of Vermont Health Care for All, a universal health care advocacy group. She is also a primary care physician. “So we, the advocates, said, ‘Well, OK, let’s not give up. Let’s do it one piece at a time.”
Richter was the first to speak before an audience of 30 health care advocates, legislators and members of the public attending the conference the Vermont Alliance of Retired Americans organized to discuss the bills.
Richter hopes universal primary care will be that first piece.
Primary care, which in Vermont includes mental health and substance abuse treatment, accounts for just 6 percent of health care costs in the state, according to Richter. She suggested this comparatively small piece would be more manageable for the state to administer than a full-scale program. Also, it’s a good place to start because the early intervention of primary care can prevent costly serious illness down the road, she said.
Richter said primary care as it is provided today is sometimes out of people’s reach because of expensive copays and deductibles.
Richter uses the example of a patient who had difficulty breathing for four days before coming to her practice, reluctant to incur medical debt. “She works. She’s insured. She has a huge deductible, and a very ill family member rang up huge debt for the family” said Richter, who diagnosed her patient as having a heart attack. “She spent three days in the ICU. She now has irreversible heart damage and will probably need a heart transplant. Guess who pays for that? Raise your hands — we’re going to pay for it.”
Paul Cillo, director and founder of the Public Assets Institute, said increasing poverty and income inequality in the state paired with what he described as a loss of confidence in state government to make it difficult to pass taxes for public health care.
Cillo said publicly funded universal primary care in Vermont would cost between $214 million and $344 million a year, based on a state report published in 2015.
Cillo said a payroll tax of 1.6 percent to 2.5 percent could cover the entire cost of a universal primary care system.
“Universal access to health care is a relatively simple concept,” he said. “You’re taking money that we now raise through premiums paid to insurance companies that then pay providers for care that we get. You’re having the state collect that money instead of the insurance companies. The difficulty is that it’s a very complicated system. The machinery that’s currently in place is very complicated. It involves providers that are all independent.”
According to Cillo, the existing health care system’s complicated nature makes crafting health care legislation a risky proposition. “No one, I can say confidently, no one understands the entire health care systems,” he said. “That makes it hard for policymakers. We have a citizen Legislature, and they’re expected to be experts and vote on this stuff — it’s frightening, frankly.”
To see these policies developed, people would need to push their representatives to act without knowing all the details, he said. “That’s the chicken and egg of this thing. You can’t sit still and wait for the details, because somebody has to do that work, and the Legislature needs to pay for that to be done.”
Ingram said she’s not sure what would happen if the bill made it to Gov. Phil Scott’s desk. “We have the governor to be concerned about as to whether he would sign it or not,” said Ingram.
Jill Charbonneau, president of the Vermont AFL-CIO, reiterated Ingram’s concern, saying the changes to health care for school employees Scott pushed this year show he’s “not so good on health care.”
Peter Youngbaer is director of the People’s Health and Wellness Clinic in Barre, one of nine clinics in the state that serve uninsured Vermonters. Youngbaer said cuts to outreach for the Vermont Health Connect exchange and the limited window for enrollment have resulted in more uninsured people showing up at his clinic.
“Our patient numbers are up 12 percent over last year,” he said. “Fewer people are insured now than were a year ago and two years ago.”
People who don’t sign up during the open enrollment period are prohibited from purchasing insurance on the exchange until the next enrollment period, unless they lose existing coverage or have another change of circumstances. Youngbaer said this can mean people are without insurance for up to a year.
“They’re stuck coming to the free clinic or the emergency room,” he said. “They have no other options in the state.”
Youngbaer estimated the rate of uninsured in the state is 7 percent, up from 3.7 percent in 2014.
The Kaiser Family Foundation estimates 5 percent of Vermonters were uninsured in 2016.
