Health Care

Statehouse preview: Affordability, psychiatric treatment top health care concerns

UVM Medical Center

UVM Medical Center’s main hospital campus in Burlington, VT. Courtesy of the hospital.

State lawmakers likely will consider a wide variety of health care issues in the 2019 session, but the underlying themes of affordability and access are not new.

A sampling of health care interest groups surveyed prior to Wednesday’s session kickoff showed that improving mental health care; preserving Affordable Care Act protections; bolstering insurance coverage; and decreasing prescription costs are among the top priorities for this year.

Advocates also said financial pressures on Vermont hospitals and the health of Vermont’s youth are important issues in the coming months.

Mental health care

Vermont’s hospitals have become a focal point of an overburdened mental health system. Psychiatric patients are enduring long waits in hospital emergency departments, where state regulators have found evidence of mistreatment.

It’s not yet clear what specific actions the Legislature might take to address the situation, but officials say increasing inpatient capacity and community supports for psychiatric patients are key concerns.

The Vermont Association of Hospitals and Health Systems says it is on board with “continued efforts to improve the mental health system at all levels.”

“We really want to be part of a solution to the mental health crisis,” said Devon Green, the association’s vice president of government relations.

Affordable Care Act protections

Several groups said they’re concerned about continued efforts at the federal level to dismantle or weaken the law, also known as ObamaCare. Vermont already has responded to some of those changes, but some say more action is needed.

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For example, the Vermont Health Care Advocate’s office is pushing for stronger state regulations on association health plans and “doing whatever we can to protect the marketplace,” said Mike Fisher, chief health care advocate.

But there will be pushback. The state’s largest private insurer, Blue Cross and Blue Shield of Vermont, says tightening the reins on association plans “does not address the myriad of federal law changes, legal challenges nationally and new rules that have threatened the (Affordable Care Act) and the stability of Vermont’s exchange.”

“Vermont should take a comprehensive approach to mitigating these impacts and strengthening the state-based exchange,” said Sara Teachout, a Blue Cross spokesperson.

Prescription drugs

In 2018, the Legislature passed bills aimed at increasing drug-price transparency and importing cheaper drugs from Canada. Lawmakers may have to take more action this session to push the importation project forward.

More generally, Fisher said his office will continue to push for drug-cost controls, as “affordability is always our concern.” And Paul Burns, executive director of the Vermont Public Interest Research Group, says he’ll be “keeping an eye on prescription drug prices.”

On a related note, Burns said he’s watching to see whether lawmakers resurrect the idea of taxing prescription opioid manufacturers to help fund addiction-related programs. “I think that may receive more attention,” Burns said.

Universal primary care

There was a strong push last year to enact a state system of universal primary care. But concerns about public funding helped to derail the initiative, which didn’t get through the House.

Burns said universal primary care “may receive some serious attention again this session, for sure.”

The advocates with Vermont Health Care For All are pledging to push hard for publicly funded primary care. Dr. Deb Richter, the group’s president and a practicing family physician, said she has firsthand experience with patients who are underinsured and forgo important preventative care.

“They tend to ration their own care, and they suffer ill health effects as a result,” Richter said. “And we see this more often in primary care than in specialties.”

“Clearly, we need first-dollar coverage for primary care, mental health and substance abuse,” she added.

Individual mandate

In reaction to federal changes, the Legislature last year approved a mandatory health insurance law that takes effect in 2020. But an advisory group subsequently was unable to agree on whether the state should enact a financial penalty to enforce Vermont’s individual mandate.

Lawmakers now face a self-imposed deadline on that front, as the statute says “the enforcement mechanism or mechanisms should be enacted during the 2019 legislative session in order to provide notice of the penalty to all Vermont residents prior to the open enrollment period for coverage for the 2020 plan year.”

Gov. Phil Scott’s administration is opposed to a financial penalty. Others, including Blue Cross, say a penalty is necessary to make the individual mandate meaningful and keep younger, healthier people insured.

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“As young people drop out of the (insurance) marketplace, the price for everyone else gets higher,” Teachout said.

Hospital pressures

The recent financial mess and executive resignations at Springfield Hospital are an extreme example of the pressures rural hospitals face.

Jeff Tieman, the hospital association’s president and chief executive officer, said his organization will be lobbying to preserve what’s left of disproportionate share payments, which help cover the cost of treating uninsured and underinsured patients. Those payments have been cut in recent years.

A health care workforce shortage also is causing an administrative and financial crunch for hospitals. Green said the hospital association has been exploring “the idea of proposing tax credits to incentivize people to take positions in health care and mental health” in Vermont.

Youth health

Children’s meal nutrition was an issue in 2018, and the American Heart Association’s Vermont chapter plans to pursue the issue again this year. A chief concern is reducing kids’ exposure to sugary drinks.

There’s also concern about use of tobacco products and e-cigarettes among young people. Both the hospital association and the Vermont Medical Society support raising the tobacco-use age limit to 21, an issue that has come up before in the Legislature but has failed to pass.

The time is right to raise the tobacco age “with all of the information coming out about youth and e-cigarettes and the high incidence of vaping,” said Jill Sudhoff-Guerin, the medical society’s policy and communications manager.

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Mike Faher

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