Primary care a key issue this legislative session

VERMONT — Primary care in Vermont is shaping up to be a key issue this legislative session.

The heightened interest comes as the Vermont Chamber of Commerce last month reported that Vermont spends 19.6% of personal income on health care, the highest share in the nation. Since 2018, health insurance premiums have increased 10 to 15% annually, with the average silver plan rising 169%, the chamber said.

Addison County lawmakers are among those who've written or co-sponsored bills aimed at reforming the state's primary and broader health care systems.

Those bills include H.433, which seeks to incrementally implement a publicly financed health care program for all Vermonters, beginning with primary care, as well as primary care access reform bill (H.680) introduced by Rep. Herb Olson, D-Starksboro.

"Primary care is the cornerstone for health care for Vermonters," Olson told the Independent. "It's where people go when they need immediate care and is at the level that is really effective, and frankly, much more cost effective than anywhere else. So, I'm a huge supporter of doing more for the primary care sector."

UNIVERSAL PRIMARY CARE

Olson is a co-sponsor of H.433, which was introduced by Reps. Brian Cina (P-Burlington), Francis McFaun (R-Barre Town) and Kevin Christie (D-Hartford) and read for the first time last year. The bill would implement Green Mountain Care, "a publicly financed health care program for all Vermont residents." The program would start by offering publicly financed primary care in its first year (as early as 2027), with additional health care services being incorporated into the Green Mountain Care benefit package over the course of 10 years.

The bill would also establish a "Universal Health Care Advisory Group," which would advise the Green Mountain Care Board and lawmakers on Green Mountain Care implementation and financing.

The bill details a couple of funding sources for the program, specifically "a payroll tax levied on all employers and a tax on self-employment income," an income tax surcharge, along with potential other sources recommended by a new Universal Health Care Advisory Group and determined by the General Assembly.

"The model in (H.433) says let's treat our health care system like we treat the best version, let me say, of Medicare, where it's a public program, everybody's in, and it's publicly-financed," Olson explained. "I think that's a good model."

He noted some cooperation from the federal government would be required to include Medicare and Medicaid patients into one universal pool with other Vermonters for the program.

"It's a viable option, it's just a question of how to get it done in both the national scheme of things and where we're at in Vermont," he said.

Olson pointed to how access to primary care without cost sharing could help the state save money. He noted cost sharing in the current health care system (such as through deductibles and copays) can create a barrier to access to care.

"You really don't want that because primary care is the way that you actually save money," he said. "You get the patient to see a primary care doc at the right time, and you're going to be saving money for the system as a whole."

Rep. Amy Sheldon, D-Middlebury, is another co-sponsor of H.433. She underscored how publicly financed primary care — and health care more broadly — could benefit Vermont's economy.

"If we had universal health care starting with primary and then moving to full coverage, you would see many of the things attracting young, creative-type people. I think it would be an investment in the economy for sure," she said. "I think that's what our country is missing, is people being free to pursue their calling versus taking jobs that they take simply or in part to get health care. I think it's an economic development tool."

H.433 is currently sitting in the House Committee on Health Care, where it was referred last year. While not members of that committee, Sheldon and Olson noted the committee is expected to look at primary care in Vermont this session, which could mean diving into H.433 along with other bills.

Hoping to encourage movement on the bill, residents in some Addison County towns have petitioned to get a resolution regarding H.433 on Town Meeting Day warnings (see related story on Page 1A). Voters in those towns would field a resolution asking whether they should "call upon the General Assembly to discuss, take testimony, and vote on H.433 during the 2026 session?"

OPPORTUNITY, CHALLENGE

Other primary-care related legislation lawmakers could tackle this session include H.680, of which Olson is the lead sponsor. That bill aims to "establish a primary care access reform program in which participating primary care providers would receive a monthly payment from the patient's health insurer or other payer for each participating patient that would cover the patient's routine primary care services for the month without any cost-sharing requirements."

Olson said a similar bill (S.197) has been introduced by Sen. Ginny Lyons (D-Williston) in the Vermont Senate. He noted the various bills (H. 433, H.680 and others) focus on different ways of improving primary care here.

Olson acknowledged the affordability of health care is a key issue in the state and primary care access offers a way to tackle it.

"Health care is definitely a real important part of that question of how do we make Vermont more affordable for us, and the research is pretty clear that primary care really can help," he said. "You focus more on primary care, make sure that patients can get in there with good access and timing and stuff, it saves money, and right now we're doing horribly."

He said it can take up to 180 days to see a primary care physician in some places and some primary care physicians aren't accepting new patients.

"It's a real problem, so we've got to change that," Olson said.

Sheldon noted there's an opportunity for the state to reimagine what health care means as a whole.

"I think we have focused so much on treating people after they get sick that the emphasis of shifting to simple things people can do in their lifestyle to feel better mentally and physically will also yield prevention of long-term illness," she said. "The opportunity we're being given by having a lack of leadership at the federal level perhaps could be turned into the opportunity to demonstrate a more holistic approach to health care in the future."