Times Argus



By Kate Barcellos



Forty-eight representatives from across the state introduced a bill on Thursday proposing universal, publicly-financed health care for all Vermonters beginning in 2023.

“This particular bill was introduced in the last and previous biennium,” said sponsor Rep. Brian Cina, P-Burlington. “We’re picking the ball up where we left off … my hope is that our committee will pass it again since our committee did last year.”

Though the bill is more of a study, Cina said, they are bringing together various stakeholders and asking them to come up with operational plan and funding mechanisms for a universal health care plan with a draft model and time line due by Jan. 2020.

“We’re empowering a group of people to come to us with a plan,” Cina said. “Every provider in the state would have the opportunity to influence it.”

“We have been working on this for years in one form or another,” said Rep. Robin Chesnut-Tangerman, P/D-Rutland-Bennington district. “Since I’ve been in, we’ve introduced a bill in the Senate every year.”

The intent of the bill, according to legislative documents, is to eliminate the cost of emergency health care required when Vermonters don’t seek out care because they can’t afford it.

“It’s one of those things where you have to spend money to save money,” Chesnut-Tangerman said. “(This) treats diseases before they become critical.”

A study completed in 2016 showed that the model would ensure fewer emergency room visits and hospital stays, resulting in an overall cost reduction for residents, and includes that health care services will be made available without cost sharing, legislative documents showed.

The stakeholders in the model — such as Bi-State Primary Care — would be overseen by the Green Mountain Care Board.

Cina said the goal would be for the Agency of Human Services to create a final implementation plan and have it in place by January 2021, so legislators are looking for information by next year for submission to the House Committee on Health Care.

Ideally, by 2022 legislators would have the opportunity to ask for waivers and approval, and coverage start by 2023.

“We believe we should provide this, but we have to do it right,” Cina said.

The attorney general’s office would work with the Green Mountain Care Board and the Office of Financial Regulation would vet the plan from a legal standpoint to make sure it didn’t undermine the Employee Retirement Income Security Act.

The plan would only be implemented if it didn’t increase administrative costs, provide reimbursement for primary care costs that attract a sufficient number of primary care providers, has appropriate financing, provides funding for mental health.

Dental health was not included in the bill.

Funding would provide for outpatient visits, preventive medicine, consultation, vaccinations, prolonged physician services, nursing services, home and assisted living visits.

It would also provide for smoking, alcohol and substance-abuse counseling and services done by any licensed health care provider.

The plan for 2023 allowed for enough time to implement the systems needed to make the program economically viable, Chesnut-Tangerman said, and though he doesn’t expect it to pass, it was assigned Thursday to the health care committee where the bill’s sponsor, Brian Cina, serves.

“Funding mechanisms take time,” Chesnut-Tangerman said. “We really tried to take the time to do it right, rather than rush something that proves to be problematic.”

Primary-care physicians are overburdened with paperwork and administrative duties, and a universal health care model would solve the issue of under-staffing in medical centers and low-reimbursement for primary-care physicians, according to the bill.

Chesnut-Tangerman said with a $6.1 billion budget to work with, they should be able to come up with a plan, and said universal health care would attract more people to relocate to Vermont.

“I think almost everyone worries about health-care coverage,” Chesnut-Tangerman said. “It’s one of those fundamental things across the country. The folks that we want to attract to Vermont are looking for things like quality schools, child care, health care, family leave and a livable wage.”

Cina said some believed that universal health care would only work on a federal level, while others still believed health care to be a product and not a fundamental human right.

So far, no opposition has coalesced yet, and Chesnut-Tangerman said he thinks there is a majority in the house who believe health care is a human right, not a privilege, and that the current health care system isn’t providing for the needs of Vermont citizens.

“We’re the only major country on earth (that) doesn’t guarantee health-care coverage to all of its citizens,” Chesnut-Tangerman said. “We should be able to do that, especially in light of the struggles of health care facilities. … It greatly reduces costs in the long run.”

“The burden comes to us to prove if, in the end, it’s viable or not,” Cina said.