[A] key House committee is backing a taxpayer-funded system of universal primary care, bucking those who have expressed concerns about such a system.
The House Health Care Committee on Wednesday voted 6-5 to support a version of S.53 that explicitly endorses publicly financed primary care. The care should be available to Vermonters “without cost-sharing,” the bill says.
The Senate last month approved language that was much less definitive. But a majority of House Health Care Committee members said they want to push the state toward health care that is more accessible and more affordable.
“Whether or not this bill survives the rest of the process and becomes a law, I think today we need to make a decision that makes a policy statement,” said Rep. Brian Cina, P-Burlington.
Other committee members dissented, citing the fact that Vermont is in the middle of implementing a new model of paying health care providers.
“This is definitely not the right time for Vermont,” said Rep. Annmarie Christensen, D-Perkinsville. “Vermont is a small state, and there’s only so much money and so many resources to go around.”
There has been push and pull for several months over S.53. Supporters of universal primary care packed a public meeting on the topic in January and have been lobbying for legislative action.
But some have been waving the caution flag.
Senate President Pro Tem Tim Ashe led an effort last month to soften the bill’s language, saying there are a “number of questions” that would need to be addressed before the state could implement taxpayer-funded primary care.
The Scott administration has opposed the bill, citing financial, administrative and policy concerns.
That debate coalesced within the House Health Care Committee in the last few weeks. With the 2018 legislative session winding down, the committee’s vote on Wednesday illustrated the topic’s continuing divisiveness.
The version of S.53 that was approved in the house committee on Wednesday was approved in early March by the Senate Health and Welfare Committee.
It calls for several years of work toward a primary care system that would be in place by 2022. The Green Mountain Care Board would pull together a group to come up with a draft operational model; assessments of the model, along with financial and legal analysis, would follow.
The bill doesn’t specify how the state would pay for universal primary care, but it makes clear where Vermont should be headed. “It is the intent of the general assembly,” the legislation says, “to create and implement a program of universal, publicly financed primary care for all Vermont residents.”
The bill also says the best system would provide primary care “without point-of-service patient cost-sharing or insurance deductibles for primary care services.” And it says the Legislature “plans to use universal primary care as a platform for a tiered approach to achieving universal health care coverage.”
Rep. Bill Lippert, D-Hinesburg and House Health Care Committee chair, said he supports that goal.
“I think it’s our responsibility as the state of Vermont to create every possibility for accessible, publicly financed health care for all Vermonters, (while) recognizing the barriers and the difficulties that this particular path creates,” Lippert said.
Rep. Betsy Dunn, D-Essex, also joined the majority vote. She cited an argument often used by universal primary care supporters: By emphasizing and enabling preventative treatment, “we prevent those long-term, higher costs that we have when people don’t have care,” she said.
Dunn also said the state’s current emphasis on the all-payer model of health care payment shouldn’t preclude primary care reform efforts.
“I think we need to look at both, because if the all-payer model doesn’t work, what will we have in its place?” Dunn asked.
But many aren’t convinced that the state should divert its attention from all-payer, regardless of the merits of universal primary care.
“The problem is that, for better or for worse, we’ve embarked on a health care reform initiative right now that makes huge alterations to how money flows through the system,” said Rep. Anne Donahue, R-Northfield and the committee’s vice chair.
“I supported (all payer) very reluctantly. I remain not confident about its potential for success,” Donahue said. “But it’s very complex. It creates huge pressures on the system in order to focus and sustain energy on it.”
Rep. Doug Gage, R-Rutland, said he’d rather focus on creating more competition in the healthcare industry and driving down costs.
“I don’t think (S.53) is really well thought-through,” Gage said. “And it doesn’t get to the root of the problem of health care.”
Christensen, Donahue and Gage voted “no” on S.53, as did Reps. Mike Hebert, R-Vernon, and Ben Jickling, I-Randolph. Jickling said he would have been more likely to support the version of the bill that passed the Senate.
Joining Cina, Lippert and Dunn in voting for the bill were Reps. Lori Houghton, D-Essex; Sarah Copeland-Hanzas, D-Bradford; and Tim Briglin, D-Thetford.
The version of S.53 approved by the committee now will go to House Appropriations, Lippert said, because funding will be needed to undertake planning for universal primary care.
“We will be looking to them to sort through fiscal issues, particularly the impact in the 2019 budget,” Lippert said.