[L]egislators on Friday took a small but significant step toward establishing universal, publicly financed primary health care in Vermont.
The Senate Health and Welfare Committee unanimously approved S.53, which would set in motion several years of work toward creating a primary care system that would take effect in 2022.
The bill does not mandate creation of such a system. Instead, it orders detailed planning and analysis, and lays out a long list of conditions — including the development of “appropriate financing” — that must be met.
But advocates said Friday’s vote was an important endorsement for an ambitious plan to expand access to primary care doctors.
“Last year, I couldn’t figure out any way to move this,” Sen. Claire Ayer, D-Addison and the committee’s chairwoman, said of a bill that was first introduced in January 2017. “This is forward progress.”
The first few pages of the bill make a case for a care system that would be available to all Vermonters without patient cost-sharing.
Universal primary care would aim to address health issues “before they become more serious and more costly,” the bill says. That could improve quality of care and patient outcomes, backers say, and could eventually lead to a decrease in “systemwide health care spending.”
In addition to benefiting patients, legislators also say the program should “create model working conditions for primary care physicians, who are currently overburdened with paperwork and administrative duties, and who are reimbursed at rates disproportionately lower than those of other specialties.”
Lawmakers have heard plenty of support for universal primary care. In January, more than 50 people spoke in favor of the program at a hearing jointly hosted by the House Health Care and Senate Health and Welfare committees.
Senate Health and Welfare also has been taking testimony on S.53. Lawmakers heard questions about the feasibility of setting up and administering the program, but they also heard from primary care advocates like Dr. Allan Ramsay, a former Green Mountain Care Board member who serves as medical director of the People’s Health and Wellness Clinic in Barre.
Two days before Friday’s vote, Ramsay told the committee to look past those who doubt the state’s ability to create a universal primary care system.
“Change is difficult,” Ramsay said. “I am sure there will be other important questions along the way, but let’s remember value. You have heard no testimony to date that has questioned the value of expanded access to primary care services.”
S.53 sets up a process to answer those questions Ramsay alluded to. That process consists of several layers of study and assessment:
• The Green Mountain Care Board would pull together and supervise a group consisting of accountable care organizations, federally qualified health centers and “other interested stakeholders” to come up with a draft operational model for universal primary care. That group will answer questions such as who is eligible for publicly financed primary care; who would deliver that care; and how funding “would move through the health care system.”
• A draft plan would be due Jan. 1, 2019.
• The state Human Resources Department and the Department of Vermont Health Access would assess that plan and report back to the Legislature by July 1, 2019.
• Also by July 1, 2019, the Department of Financial Regulation would weigh in.
• The state attorney general, the Green Mountain Care Board and the Department of Financial Regulation would be tasked with preparing a legal analysis due Jan. 1, 2019.
• The care board also would convene a “working group” this year to examine issues such as services that should be included in the primary care program and ways to resolve “coordination of benefits issues.”
The working group’s report would be due Oct. 1, 2018.
Sen. Ginny Lyons, D-Chittenden, said it’s important that the planning effort relies on the expertise of people working in the current health care system such as hospitals, insurers and accountable care organizations.
The idea is to put “all of those people into the room to figure out how to take the resources that we have, within the system, and utilize them effectively to provide free primary care to the citizens of Vermont,” Lyons said.
At the same time, committee members emphasized that much of the preliminary legwork would be performed by state agencies.
“We’re calling it our D.I.Y health care bill,” Ayer said. “Nobody’s climbing over fences to do this work for free. But they’ve all agreed to do it. It’s a great thing.”
After all studies are complete, S.53 calls for the Agency of Human Services to submit a final implementation plan by Jan. 1, 2020.
“The Legislature is supposed to come up with a financing plan for the whole thing in 2020, and it’ll go live in 2022 – that’s the dream,” Ayer said.
At this point, financing may be the biggest question mark. S.53 only generally alludes to funding sources including appropriations from the Legislature; revenue from still-unidentified taxes; and federal funds from Medicaid if authorized by federal waivers.
Legislators are also looking for a smaller revenue source that might provide, in Ayer’s words, “a little pocket money” to support the initial planning effort. At one point, Ayer proposed dipping into hospitals’ “excess revenues” to find that money.
But the committee on Friday eliminated that language. Instead, the bill now proposes to use up to $300,000 in state and federal money that has been set aside for transitioning to Vermont’s all-payer health care model.
Jeff Tieman, president and chief executive officer of the Vermont Association of Hospitals and Health Systems, said the association opposed the committee’s original plan to take hospitals’ excess revenues. He said hospitals are already supporting expanded access to primary care via their participation in the all-payer model, which emphasizes preventative care.
Tieman said hospitals “fully support everyone having access to affordable primary care.” But he added that the association wants to ensure that the push for universal primary care doesn’t jeopardize other health care reform efforts already under way.
On the other hand, advocates like Vermont Businesses for Social Responsibility are unequivocally backing S.53. Dan Barlow, the organization’s public policy manager, said Friday’s vote is the first time in several years that the Legislature “has made an attempt to get back to the larger vision of universal health care – starting with universal primary care.”
“So we see this as a really positive step forward,” Barlow said.
