[A]dvocates for a publicly financed, universal system of primary health care are trying again to advance the initiative after it stalled in the state Legislature last year.
H.129, which was introduced last week, calls for a universal primary care system to be in place by 2023.
Many questions remain, including how the state would pay for such a system. But Rep. Brian Cina, P/D-Burlington and the bill’s lead sponsor, said public financing is critical to ensuring universal access to preventative care.
“By investing in universal primary care, we can improve population health and save lives and save money,” Cina said.
The current push for universal primary care has roots in Act 48, the sweeping 2011 health care law that said the state “must ensure universal access to and coverage for high-quality, medically necessary health services for all Vermonters.”
The state has not made significant progress toward a universal health care system, but proponents of universal primary care say it would be a first step.
“Vermont made a promise to the people with Act 48 that we were going to provide universal health care, and that health care was a right, and that it was a public good and not a product,” Cina said. “That’s the direction that we’re trying to go in. This bill continues that work toward establishing a piece of the health care system as a public good.”
A key point of contention is whether taxpayers can or should foot the bill for primary care.
Last year, both the Senate Health and Welfare Committee and the House Health Care Committee approved a bill endorsing publicly financed primary care for all Vermonters. But the full Senate approved a version of the bill without any guarantee of public financing, and the primary care bill never made it to the full House for a vote.
Senate Pro Tem Tim Ashe was among those expressing concern about taxpayer funding. Also, Gov. Phil Scott’s administration opposed the bill for financial and policy reasons.
H.129 advocates for public funding to support a system “that provides primary care for all residents without point-of-service patient cost-sharing or insurance deductibles for primary care services.” Such a program should ensure that residents “have access to primary health care without facing financial barriers that might otherwise discourage them from seeking necessary care.”
The bill also seeks to create “model working conditions” for primary care providers who are “overburdened with paperwork and administrative duties, and who are reimbursed at rates disproportionately lower than those of other specialties.”
It’s generally accepted that enhancing access to primary care can boost Vermonters’ health and, in many cases, reduce health care costs by finding and treating medical problems before they get more serious.
But at this point, no one is sure about the best way to set up a universal system. Like last year’s bills, H.129 calls for years of study and work before implementing the program.
Under Cina’s bill, the Green Mountain Care Board would convene a group of interested parties to develop a draft operational model for universal primary care. Considerations would include who would be eligible, who would deliver care and “how funding for the primary care services would move through the health care system.”
The care board’s draft plan would be due Jan. 1, 2020. Subsequently, state entities including the Department of Human Resources, the Department of Vermont Health Access and the Department of Financial Regulation would get involved in the planning process.
Also, the attorney general, in consultation with other agencies, would undertake an “analysis of any potential legal issues” for a universal primary care program. That would include possible conflicts with federal regulations.
A final implementation plan would be due at the beginning of 2021.
Also that year, the Legislature would enact a “funding mechanism or mechanism” for the program. The bill says a universal primary care system cannot be implemented unless there is “appropriate financing in place to support the covered services while ensuring the continued solvency of the program.”
H.129 would establish a universal primary care fund to accept transfers from the state’s general fund or “revenue from any taxes established for the purpose of funding universal primary care.”
Cina said he defers to the care board and other entities involved in primary care planning to come up with a funding source. “I’d like to give them a chance to do that work before I weigh in,” he said.
There does not appear to be a companion Senate bill for H.129. But Cina said it makes sense for the House to push the matter forward.
“The ball was dropped (last year) in the House,” he said. “I want to pick it back up in the House.”
