This commentary is by Miriam Tatum, of Derby. Tatum is a retired pediatrician in primary care and community hospital care for 30 years in Newport and Derby Line. She is an ally of the Vermont Worker Center.
Almost a year ago, Newport and Northeast Kingdom residents first heard that a consultant to the Green Mountain Care Board recommended converting North Country Hospital’s inpatient, emergency room and surgical services to primary care offices and an urgent care clinic.
Fortunately, hospital leaders and concerned citizens spoke up immediately to correct the consultant’s data and to remind the Green Mountain Care Board that without a fully staffed emergency room in Newport, a resident from the Northeast Kingdom could face a one- to three-hour ambulance ride to lifesaving care.
The hospital board rejected the consultant’s recommendation and took quick action to decrease administrative costs, improve billing services, protect recruitment and retention, and begin collaboration with St. Johnsbury’s community hospital for needed specialty care. As reported recently, the hospital’s budget for 2026 leaves inpatient, surgical and emergency room services intact, and has been approved by the Green Mountain Care Board as submitted.
Meanwhile, statewide efforts at health care payment reform, launched in 2017 as the all-payer model have not met their target goal of containing health care costs while improving population health.
OneCare Vermont, the accountable care organization that administered the all-payer model, will shut down at the end of 2025, and Vermont plans to sign on to a new program named the All Payer Health Equity Approaches and Development, or AHEAD, with a timeline of 2026 to 2037. It would be supported with funds from Medicare, Medicaid and commercial insurance companies. Oversight of payers and hospitals by the Green Mountain Care Board and the Vermont Legislature is expected to continue.
Will this second version of payment reform be any more successful than the first?
Hopefully it won’t be challenged by another pandemic with the shutdown of hospitals. But it will face funding cuts (no more premium subsidies on Vermont Health Connect) that leave more Vermonters uninsured and inevitably shift the burden of care to hospitals.
Future funding cuts scheduled for 2027 will threaten successful Vermont programs like Dr. Dynasaur, Blueprint for Health, the Vermont Department of Health with community health workers, Support and Services at Home, and Supplemental Nutrition Assistance Program, or SNAP.
It will be difficult to improve population health in our community without these proven cost-effective services.
Why does Vermont keep choosing an all-payer approach to health care reform, as if bringing in — and regulating — the payers will be the solution?
Perhaps it’s time to boldly shift our focus to insuring all people with universal health care that is state-administered and privately delivered. We are already on that path, which Vermont legislation passed in 2011 to create a single-payer system (though it was never implemented), and with Vermont hospitals already accustomed to operating on pooled funds from Medicare, Medicaid and commercial insurances.
If we’re told the single-payer model is too expensive or won’t work, let’s remember that the current system doesn’t work and costs too much — not just in dollars, but in our own health and our communities’ health.
