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To the Editor:

In the face of underperformance by OneCare Vermont, the Scott administration has issued an “Implementation Improvement Plan.” The assumption behind this reboot report is that the model is sound and merely needs adjustments. But the report fails to address the biggest problems that Vermont residents face in accessing healthcare.

The inability of OneCare, the state’s sole accountable care organization (ACO), to meet the health needs of Vermont residents will not be solved by improvement schemes. Governor Scott claims that it revamps the healthcare system through payment reform, but payment reform does not address the greatest barriers to care: access and affordability. It does not solve the problems of the uninsured or underinsured. It does not do away with high out-of-pocket costs. It does not deal with uncovered services or erase medical debt. OneCare does not solve these problems because it is not designed to do so.

Vermont’s healthcare law, Act 48, states that Vermont “must ensure universal access to and coverage for high-quality, medically necessary health services for all Vermonters.” When power-holders signed the all-payer model waiver that ushered in the ACO, they abandoned that commitment in favor of a program that attempts to control costs by getting people to “consume” less healthcare. In addition, they privatized what should be a public good by siphoning millions of Medicaid and Medicare dollars into OneCare Vermont, a private company run by UVM Medical Center and Dartmouth-Hitchcock.

It’s time to acknowledge that this model can’t ensure universal access, no matter what sort of tweaks or recalibrations they make. It’s time to cut the contract with OneCare and to get back on track towards providing healthcare as a public good for all in Vermont.

Ellen Schwartz,