[T]he 2018 legislative session was a roller-coaster ride for advocates of universal primary care in Vermont.
Supporters celebrated when the primary care bill, S.53, advanced with public financing mechanisms built in. And they rallied behind the bill when state legislators questioned the feasibility of taxpayer-funded health care.
But the campaign ended on May 12, with S.53 stalled in the House Appropriations Committee as the Legislature adjourned. Rep. Kitty Toll, D-Danville and House Appropriations chair, said the legislative schedule was the biggest factor in the bill’s demise.
“We did receive the bill quite late in the session,” Toll said. “And being such a complex bill, to get the amount of work done that Appropriations felt it needed, we simply ran out of time.”
It was a quiet end for a bill that generated a lot of debate, starting with a late January legislative hearing that was packed with universal primary care advocates.
Less than six weeks later, the Senate Health and Welfare Committee approved a version of S.53 that endorsed creation of a publicly financed primary care system with no patient cost-sharing, though several years of study were required and no funding mechanism was specified.
The bill ran into trouble soon after, with Senate President Pro Tem Tim Ashe saying the state may not be ready for taxpayer-funded primary care. The Senate eventually approved a compromise version of S.53 that backed off public financing but left the door open for some form of state assistance.
The debate shifted again in the House, where a divided Health Care Committee on Apr. 25 narrowly approved restoring public-financing language to S.53, in spite of opposition from Gov. Phil Scott‘s administration, which expressed financial, administrative and policy concerns.
S.53’s next – and final – stop was House Appropriations. Toll said her committee was far too busy to do any heavy lifting on the primary care bill.
“The focus on the budget at the end of the session seems to trump many other aspects of the end game,” Toll said. “And we had a tremendous amount of bills come to us in the last two weeks that we were going through.”
Timing wasn’t the only problem. Toll said her committee had legal concerns and financial questions about “the actual costs” of publicly financed primary care. There also were questions about how such a program would interact with the state’s ongoing effort to implement the all-payer model, a new health care payment system.
“It would take a significant amount of time to get the detailed information that House Appropriations would have needed to consider it and be comfortable taking a vote on it,” Toll said.
Lawmakers are returning to the Statehouse soon for a special session to address budget and tax issues, and House Speaker Mitzi Johnson has said legislators also will take up “some bills that didn’t make it to the finish line.”
But that applies to bills that were up for a final vote as the session ended. S.53 hadn’t made it to that point.
That means universal primary care advocates are turning their attention to the 2019 legislative session.
The end of S.53 is “a disappointment for those who feel so strongly about this,” said Dr. Allan Ramsay, who serves as medical director of the People’s Health and Wellness Clinic in Barre. “I think it’s also a disappointment for the grassroots support we got throughout the state.”
But the debate is not over, Ramsay said. “Because we were able to generate that degree of public support, I think this will keep the universal primary care bill alive,” he said.
Advocates argue that publicly funded access to primary care doctors will improve Vermonters’ health and save money. The idea is that many more people will seek preventative care, thus heading off far more serious and expensive health problems.
Ramsay, a former Green Mountain Care Board member, also argues that “access to health care is a bipartisan issue.” That’s especially important, he said, as federal policy changes and insurance-premium increases make it more likely that some will forgo health insurance.
“It’s all about access,” he said. “And our current reform measures … do not focus on increasing access to health care services at a time when fewer people are going to be covered.”
