This commentary is by Kenyon Bolton. He is an internal medicine physician who lives in East Montpelier.
It is already difficult to find a new primary care clinician in Vermont. The “One Big Beautiful Bill” making its way through the U.S. Congress will likely make it harder thanks to its proposed Medicaid work requirements and more frequent eligibility recertifications.
I am an internal medicine physician who works in hospital medicine. I love primary care and volunteer in an outpatient clinic, but chose employment in the hospital setting in part due to the administrative burdens increasingly placed on primary care.
Primary care clinicians already have the unenviable task of gatekeeping many social services. When not in the exam room, they are completing paperwork for their patients’ disability determination for social security, special education services, substance use disorder support, home health services, housing and food assistance and family medical leave, in addition to onerous tasks related to documentation and insurance.
A well-staffed office works hard to help manage this load, but the pile of paperwork ends up on your doctor’s desk next to critical lab results, radiology findings, prior authorizations and medical charting.
The degree of administrative burden on primary care is uniquely American.
Compared to countries with more robust social safety nets and universal healthcare, U.S. physicians spend more time on administrative tasks, including screening for and managing social issues. Based on a recent survey compiled by the Vermont Medical Society, we know that Vermont clinicians report burnout just from prior authorizations alone. Vermont physician leaders have recently sounded the alarm regarding these cumulative pressures on primary care.
With its enactment of Medicaid work requirements, the bill will double down on bureaucratic burdens for primary care, not to mention the Americans who depend on Medicaid. As written, the House bill would exempt “medically frail” people from work requirements, which will likely require clinician approval.
Additionally, the bill requires more frequent Medicaid eligibility recertifications, up from annually to every six months. This is a known contributor to “enrollment churn,” where enrollees lose and regain coverage. Churn increases administrative costs to states, ups the number of ED visits and hospitalizations, and swells burdens on both practices and patients.
Not only will the One Big Beautiful Bill’s Medicaid cuts likely lead to increased mortality, put rural hospitals at risk of closing, and cause confusion for patients, it will probably increase the administrative burden on your primary care office. I’m not the only doctor who has steered away from primary care because of its unwieldy administrative demands as things stand, and we should all expect Vermont’s primary care shortage to worsen with this bill.
In recent VTDigger commentaries, Alex Messinger urged Vermonters to connect with their family and friends in red states to oppose the bill’s cuts to clean energy incentives, and Dr. Julie Ehrlich at UVM has highlighted the bill’s impact on pediatric care.
Additionally, we can urge Gov. Phil Scott to join our federal delegation in vocally opposing the One Big Beautiful Bill for the sake of our state’s primary care practices. I was glad to see that he did not join his Republican colleagues in supporting the bill. Let’s take the next step and call on him to join the bipartisan opposition to Medicaid cuts.
