The Senate on Wednesday advanced a bill that could result in a new system of universal primary health care in Vermont.
But there’s a long way to go before the health care system envisioned in S.53 would be a reality. And the compromise version of the bill that won preliminary Senate approval does not explicitly endorse taxpayer-financed primary care, as earlier versions did.
Some supporters said they’re satisfied that S.53 identifies a possible path toward making primary care accessible to all.
“The structure this sets in place gets us closer,” said Sen. Claire Ayer, D-Addison and chair of the Senate Health and Welfare Committee. “(It) could get us to an actual plan of operations by the end of next year.”
But others said they couldn’t support a bill that doesn’t call for publicly financed health care.
“I am going to oppose this amendment because I do not feel like surrendering,” said Sen. Jeanette White, D-Windham.
Supporters say an expanded primary care system, by improving the health of Vermonters, and supportingt the diagnosis and treatment of illnesses before they become more serious and more costly, ultimately will decrease overall health care costs in the state.
The question, however, is how the state can provide primary care that is both more affordable and more accessible.
Earlier this month, Ayer’s committee approved a version of S.53 that set up several years of study leading to the creation of a universal primary care system in 2022. The bill proposed a publicly financed system with no cost-sharing, though it did not identify specific taxes that might be imposed.
But the Senate Appropriations Committee last week recommended extensive modifications to the bill.
The committee’s version said universal primary care could be “publicly financed or covered by health insurance or other means.” It also urged a study of “how to make coverage for primary care services affordable for all Vermonters, such as through income-sensitized, state-funded cost-sharing assistance.”
Senate President Pro Tem Tim Ashe on Tuesday defended the Appropriations Committee’s amendment, saying he could not yet endorse a taxpayer-funded primary care system.
Wednesday’s vote in the full Senate was the result of a compromise that added additional language proposed by Ayer to the Appropriations Committee’s version of the bill.
There’s still no commitment to public financing. Rather, the Green Mountain Care Board and other interested parties would look into how to set up a universal primary care system and report back to the Legislature by Jan. 15, 2019.
If the care board “determines that achieving universal coverage for primary care in Vermont is feasible and that the benefits to Vermont residents outweigh the estimated financial costs,” then the board would prepare a preliminary draft plan by Oct. 15, 2019. A final draft operational plan would be due by Jan. 15, 2020.
The bill also commits to giving the care board “sufficient resources” to do primary care-related work.
Sen. Jane Kitchel, D-Caledonia and chair of Senate Appropriations, acknowledged “disappointment” that the bill doesn’t endorse a publicly funded system. But she and others said it shouldn’t be interpreted as a lack of support for universal primary care.
“I think we’d all say that we’re in agreement that access to primary care services is really key to health care reform and good population health,” Kitchel said.
Ayer added that the newest version of S.53 “asks the same questions that were asked in the underlying bill,” though it “leaves the door open” for a financing method.
But not everyone was satisfied with the progress represented in S.53. Sen. Dick McCormack, D-Windsor, said he would back the bill but said his vote should be considered “more of a surrender than a negotiated agreement.”
“I think it is very unfortunate that this is as far as we are going to get,” McCormack said. “It seems to me that what we’re doing now is asking, ‘Should we do this,’ rather than saying, ‘We’ve decided we should do this’ and asking, ‘How shall we we do it.’”
Sen. Anthony Pollina, P/D-Washington, said he wouldn’t support S.53 in its current form. Universal primary care “really needs to be publicly financed if it’s going to work,” Pollina said.
On a roll call vote, 24 senators supported the latest amendment to S.53. Six voted against it.
One more Senate vote is required before the bill goes to the House.
