Plan to bring greater fairness to health care heads to the state Senate

A bill designed to address disparities in Vermont's health care system won approval Friday from the Vermont House. 

The legislation, H.210, would establish a Health Equity Advisory Commission "to promote health equity and eradicate health disparities among Vermonters," particularly people of color, LGBTQ individuals and people with disabilities. It would also put the state on a path to creating an Office of Health Equity.

People of color have been disproportionately affected by Covid-19. Rep. Bill Lippert, D-Hinesburg, chair of the Committee on House Health Care, said while people of color comprise 6% of Vermont's population, they have experienced 20% of the state's Covid-19 cases. 

In addition to higher susceptibility to the coronavirus, people of color have poorer access to health care, Lippert said. That holds true for LGBTQ individuals and people with disabilities as well. All three groups also have above-average rates of chronic disease and mental health problems. 

"It's clear that these Vermonters in these communities face prejudice, discrimination and racism that's often invisible to others. They often feel misunderstood and not trusted. They don't trust the system; they don't feel valued, included or safe. They feel like services are often not designed to support them," Lippert said. 

The legislation, which passed on a voice vote Friday, will now be taken up by the Senate.

The Health Equity Advisory commission would create guidance on forming a state Office of Health Equity. It would shape the structure and duties of the office, and set standards for programs and award grants. 

In addition, the 27-member commission would issue an annual report with findings and policy recommendations and would advise the Legislature on improving "cultural competency and antiracism in the health care system."  

The commission members would include Vermont residents appointed by state officials — involving the commissioners of housing, health and mental health — and residents selected by organizations including the Pride Center, Migrant Justice and state branches of the NAACP. 

Rep. Kevin “Coach” Christie, D-Hartford, one sponsor of the bill, said the commission will “have an opportunity to identify where we can do collectively a better job in being more responsive."

“Having members of the community that either totally represent, or are associated directly with those Vermonters, we’ll be able to do a better job in our delivery of services,” Christie said. 

The initial version of the bill would have immediately established an Office of Health Equity within the Vermont Department of Health. But state officials said the health department has been preoccupied with responding to the Covid-19 crisis. 

"Our conclusion was that it was not the time to ask the Department of Health to take on an additional initiative at this point in time, but we were determined to try to move this forward," Lippert said. 

The Vermont Racial Justice Alliance, which pushed for the health disparities legislation, had asked lawmakers to make more immediate and transformative changes. 

As originally written, the legislation proposed grants to community-based organizations to fund "special research, demonstration and evaluation projects" designed to reduce or eliminate health disparities in Vermont. 

Mark Hughes, executive director of the Vermont Racial Justice Alliance, wanted a requirement that medical professionals receive two hours of additional training in "cultural competency in the practice of medicine" in order to renew their licenses. 

Those provisions didn't make it into the legislation. 

"Essentially, they gutted the bill," Hughes said. 

The legislation also puts off establishing an Office of Health Equity, which he said is critical to form now as the state grapples with the Covid-19 crisis. 

"My challenge would be, just watch and see what goes to the floor of the House and the Senate, and weigh in your mind whether that would be something that would be more important than health equity, especially in the middle of a global pandemic," Hughes said. 

Lippert said the House wanted to find a path forward, “rather than to just stop and say, ‘Oh, we can't do this.'" 

“In the course of that, we made efforts to continue with what the bill as introduced was doing, which is really, in my view, a large part was amplifying the voices of the affected communities, and empowering those in the affected communities,” he said.

The bill would assign the Health Equity Advisory Commission to issue a report by October 2022 with recommendations on improving "cultural competency and antiracism" in the medical field through training, continuing education requirements and state investments.

Christie said the legislation is a starting point for long-term change. 

“If we had our druthers, of course we’d want to have it all done at the same time, but sometimes it just doesn’t occur,” Christie said. “There's a lot of folks that are committed to this work and will stay committed, and as long as we do that, we can get to that point."