It was 4:30 on a Friday afternoon when Dr. Anne Morris faced a problem that may sound all too familiar for many primary care providers. By Morris’s telling, a patient looked at her, teary-eyed, and asked, “Why does everything have to be so hard?”
In this particular instance, Morris, who is a primary care physician and the associate dean of primary care at UVM’s Larner College of Medicine, was trying to recommend physical therapy for a patient with a persistent shoulder injury, but the patient couldn’t afford it. It’s a sentiment she’s heard from patients on Medicare and from others who buy their insurance on the Affordable Care Act marketplace: So many people are forgoing care because even with insurance, its cost can just be too high.
It’s exacerbated, Morris said, by the fact that it’s hard for Vermont to recruit and retain primary care doctors. As of December, Vermont had 79 open postings for primary care physicians, according to Morris. When that happens, it means doctors are harder pressed to provide the same amount of care, with less time for each patient. Longer, continuous relationships between a provider and a patient can significantly reduce the need for higher level and emergency care, Morris explained.
The challenge is one that has become “a top priority in this building,” according to Sen. Ginny Lyons, D-Chittenden Southeast, who chairs the Senate Health and Welfare Committee. Specifically, lawmakers plan to address the problem through S.197, a broad primary care bill that seeks to change the way patients access primary care by changing the ways we, as a state, pay for it.
But, the plan on the table is a bit counterintuitive: “We’re proposing,” Morris said, “to invest more money in primary care, while trying to reduce the amount of money that’s going into the health care system as a whole.”
Still, she noted that for every dollar spent in primary care, the broader system saves $13.
As with all things payment reform, the mechanisms are complex — and complicated further by the fact that the state already has trialed parts of these systems and is hoping to simplify them with the new influx of cash that the federal Rural Health Transformation grant is expected to bring.
Over all of this, OneCare’s attempts to pioneer a similar version of payment reform casts a precautionary shadow. “One of the biggest barriers to getting this program up and running,” Tom Borys, the CEO of that payer reform model, told the committee, “is going to be on the payer side of the equation.”
His organization essentially bundled payments from many payers (Medicaid, Medicare and some commercial insurers) to then pay providers, before it sunset at the end of 2025.
The problems patients and providers are facing with primary care are seemingly as plentiful as the proposed payment solutions. And we’re just at the precipice of seeing what path the Legislature plans to take.
— Olivia Gieger
In the know
Some of Vermont’s most critical emergency response equipment is stored in “abominable” conditions in an aging garage at the Fort Ethan Allen complex in Colchester, Jennifer Morrison, the state’s commissioner of public safety, told the Senate Institutions Committee Thursday.
The garage serves as a base of operations for Vermont’s Urban Search and Rescue team and houses much of the equipment for the state HAZMAT Response Team. But the state has relied on the facility — originally meant to be temporary — far longer than it should have, Morrison said.
“We need to have appropriate storage for the equipment. But, we also need an appropriate place for the people who work in that building,” she told the Senate panel.
In its slate of proposed midcycle adjustments to the biennial capital construction bill, Gov. Phil Scott’s administration is asking lawmakers for $500,000 to plan out a new emergency response services hub, perhaps co-located with some more specialized Vermont State Police units.
The administration hopes to have schematics — and a price tag — to present to legislators next year, Morrison said.
— Shaun Robinson
Another candidate is joining the 2026 race for the Chittenden Central Senate district. Elaine Haney, the former executive director of Emerge Vermont, plans to announce her bid for one of the district’s three seats Monday, according to a press release.
“With more than a decade of experience in local government, Haney has worked directly on the issues facing fast-growing communities in Chittenden County, including housing and affordability, rising education and property tax pressures, infrastructure needs, and balancing growth with strong local decision-making,” her campaign said in the release.
Haney lives in Essex Junction and currently serves on the City Council there. She is running as a Democrat.
Nikhil Goyal, an adjunct assistant professor of sociology at the University of Vermont and former adviser to Sen. Bernie Sanders, I-Vt., announced his Democratic/Progressive bid for a Chittenden Central seat earlier this month.
The district, which is Vermont’s most urban and diverse, is currently represented by Pro Tem Phil Baruth, a Democrat/Progressive; Sen. Tanya Vyhovsky, a Progressive/Democrat; and Democratic Sen. Martine Gulick.
— Shaun Robinson
On the move
After receiving hundreds of emails about the governor’s two latest appointees for the Vermont Supreme Court, senators in the Judiciary Committee on Thursday failed to vote in favor of supporting Michael Drescher and voted unanimously to recommend Christina Nolan. The two nominees are expected to face a confirmation vote from the full Senate Tuesday.
Both candidates formerly served as the top federal prosecutor for Vermont under President Donald Trump and were tapped by Gov. Phil Scott this month to sit on the state’s highest court. But under the microscope of senators, Drescher has faced criticism for representing the federal government in historic immigration cases, like those challenging the detentions of Mohsen Mahdawi and Rümeysa Öztürk.
Senators who opposed endorsing Drescher cited his history of arguing in court on behalf of the Trump administration — especially amid mounting public pressure.
You can read the full story here.
— Charlotte Oliver
Notable numeral
Last year was one of the highest, if not the highest, revenue-generating years for Vermont’s estate tax. According to the Joint Legislative Fiscal Office, the tax generated more than $55 million.
With Vermont’s aging population, there’s reason to believe estate tax receipts may increase, according to legislative economists.
— Ethan Weinstein
‘Chipper’ committee
“We usually do this before we start, but I’m gonna do it at the beginning.” Sen. Ginny Lyons, D-Chittenden Southeast, opened the Senate Health and Welfare Committee this morning by reading off a yellow card with a smiling mouth illustration.
“This is great for all of us: Write down three things you’re grateful for. That’ll keep you chipper.”
— Olivia Gieger
