“We’re acutely aware of the crisis of potentially losing several Vermont hospitals through bankruptcy, and the fact that BC/BS is struggling largely due to the cost for services at our hospitals.”
— Rep. Mari Cordes
MONTPELIER — While revamping Vermont’s education funding system and expanding its housing stock are topping lawmakers’ battle cries heading into the 2025 session, a growing chorus of voices is urging the General Assembly to revisit another longtime priority that continues to languish: Reform of the state’s healthcare system.
It’s a system that’s becoming increasingly expensive as Vermont’s aging population transitions to more care-reliant seniors served by state and federally subsidized programs (like Medicare and Medicaid) that simply aren’t covering the true costs of services.
Middlebury’s Ellen Oxfeld — a longtime advocate for a universal, publicly financed healthcare system for Vermont — is circulating an online petition (tinyurl.com/2ufks47v) through change.org that’s calling on Gov. Phil Scott and the Legislature to “hold open hearings to provide citizens of Vermont an opportunity to testify on their experiences with health care and what needs to be done to provide quality, affordable healthcare to all.”
Oxfeld, a professor of anthropology at Middlebury College, is also a member of “Vermont Healthcare for All,” a nonprofit created in 2003 for “educating the public about the advantages of a universal publicly financed health care system for Vermont.”
“We’ve got to get healthcare back in the center of discussion,” Oxfeld told the Independent.
While healthcare hasn’t been a central actor during recent legislative sessions, it’s played a strong supporting role. Annual, unabated, double-digit hikes in school employee health insurance premiums have contributed to soaring education property taxes. Finding a primary care provider can be a huge chore. Grace Cottage Hospital in Townshend, Gifford Medical Center in Randolph, North Country Hospital in Newport and Springfield Hospital are in particularly bad financial shape, according to a consultant’s recent evaluation of the state’s healthcare system.
Don George, president and CEO of Blue Cross and Blue Shield of Vermont, said in a letter to lawmakers last week that the ever-rising costs of healthcare and insurance premiums here “threaten the viability of our entire healthcare system and are challenging our economy.”
“Until Vermont’s healthcare leaders come together to address our state’s soaring costs head-on, premiums will continue to rise, more Vermonters will lose coverage, and the fabric of our healthcare system will continue to fray,” George said, noting that Blue Cross Vermont’s spend is 33.5% higher than the average for Blue Cross plans in the Northeast and 42.7% higher than the national average.
Oxfeld acknowledged individual legislative committees have in recent years taken healthcare-related testimony, but she argued the Statehouse hasn’t — since 2018 — hosted a joint session of the House and Senate Health & Welfare Committees during which Vermonters could publicly air their concerns about how the growing expense and narrowing availability of healthcare is affecting them.
Those concerns are even more acute than they were seven years ago, according to Oxfeld.
“On the one side, the Green Mountain Care Board is trying to rein in costs because (health insurance) premiums are going up so much,” she said. “And it’s fair to say the GMCB is in conflict with University of Vermont Health Network, which is threatening to cut what I would say are needed services…
“We haven’t really heard people’s healthcare stories,” she added.
Many of those stories are grim. Oxfeld said legislative bills will be filed this session to move toward universal access to primary care and to make hospital care a human right. Bills were still undergoing revisions and hadn’t been assigned numbers as the Independent went to press.
In her leadership role with Vermont Healthcare for All, Oxfeld networks with many legislators. She said she’s found some lawmakers to be “overwhelmed” by the state’s healthcare crisis and believes “no one is saying the system is working really well right now.”
The breadth of the problem was hammered home to Addison County residents last July by Dr. Bruce Hamory, an independent clinician hired by the Green Mountain Care Board to recommend ways of revitalizing the state’s financially floundering healthcare delivery network.
Hamory and a team of consultants found, among other things, that:
- Nine of the state’s 14 hospitals ended fiscal year 2023 with negative operating margins. Middlebury’s Porter Medical Center was among the few that finished in the black.
- The median household income in Vermont had increased by 22% (from $60,781 to $73,991) between FY2018 and FY2022. Over that span, the monthly premium for the lowest cost Silver marketplace health insurance premium increased by 108%, from $474 to $948.
- Vermont’s aging population will only get more reliant on a healthcare system that’s struggling to recruit workers who can’t find affordable housing. Right now, 12.4% of the state’s population is 65-74 years old. That age block is expected to become 24.4% of the population by 2040, when the age 20-64 set — essentially, the state’s workforce — is expected to account for only 40.3% of the total population.
- During the past decade, the GMCB has OK’d hospitals’ annual revenue growth at around 5%. At the same time, commercial insurance companies have been experiencing regular annual losses paying healthcare expenses using insurance premiums. BlueCross-BlueShield in particular has reported big losses.
Hamory, during a meeting at Middlebury’s Ilsley Library, characterized Vermont’s current malaise as a “syndemic” — multiple illnesses battling within an organism.
Oxfeld believes single payer is the ultimate cure for the state’s healthcare system ailment, but acknowledged it’s a transition that can’t be made overnight. The state appeared poised to give it a try a decade ago, but then-Gov. Peter Shumlin pumped the brakes in 2014, citing the substantial tax increases that would be required to pay for it.
Vermont Healthcare for All members counter that “providing everyone in Vermont with comprehensive care would not cost any more than the $6.5 billion we already spend on health care,” according to their literature. “One-third of all that money goes to administrative overhead in our privatized fragmented system. The hundreds of millions of dollars we waste on unnecessary administrative costs can be redirected to pay for everyone’s care.”
HEALTH EQUITY MODEL
Meanwhile, the Green Mountain Care Board on Tuesday voted 3-1, with one board member abstaining, to sign a state agreement with the federal Centers for Medicare & Medicaid Services (CMS) to become an official player in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model.
AHEAD is a federal program launched by CMS that “would allow Medicare to join Vermont’s health care reform efforts,” according to the Vermont Medical Society. “The Model would begin in 2026 and replace Vermont’s All-Payer Model.”
The main components of the AHEAD Model, which would be in place for nine years, are:
- Hospital Global Budgets, where hospitals will be paid a fixed amount of revenue, or a “global budget,” to provide services to Medicare fee-for-service beneficiaries.
- Primary Care AHEAD, a voluntary program for primary care practices to receive an additional payment from Medicare to provide coordinated care to Vermonters with Medicare coverage.
Vermont is in line to receive up to $138.9 million in federal funding that could be used to support primary care, among other things, according to HealthFirst, which represents health care practitioners working at physician-owned practices in Vermont.
“The AHEAD Model continues funding for primary care, the Vermont Blueprint for Health, and the Support and Services at Home (SASH) program,” said GMCB Chair Owen Foster. “These dollars are critically important to the state, and execution of the state agreement maintains an option as the state seeks paths out of our affordability, access, and health system sustainability challenges.”
Oxfeld and her colleagues aren’t sold on AHEAD. They called it “not a good fit for Vermont,” arguing it won’t help make the state’s healthcare system more affordable and accessible, nor help it fill the many job vacancies in that sector.
“It’s just another iteration of the idea that the problem is ‘fee for service,’” she said, arguing that “the (Gov. Phil) Scott administration is all in on this because they’ve been promised $138.9 million — that’s the carrot.”
The state’s swerve to AHEAD is just another reason why Vermonters should be invited to weigh in on healthcare at the Statehouse, according to Oxfeld. Her petition on Wednesday had garnered 590 signatures. She’s hoping to get more than 1,000. She and other supporters are broadcasting the petition through social media and word of mouth.
LAWMAKER RESPONSE
So how is the petition likely to be entertained?
Rep. Mari Cordes, D-Bristol, is the county’s lone member of the House Healthcare Committee. A longtime Registered Nurse, Cordes said she supports the petition’s intent.
“I always support the public coming to their house to share their experiences and problems with healthcare,” she said.
That said, she noted her committee continues to track the state’s healthcare woes from multiple angles — including from patients.
“We hear from constituents and businesses every day about how the healthcare crisis is impacting them; some legislators are feeling it themselves,” she said. “We’re acutely aware of the crisis of potentially losing several Vermont hospitals through bankruptcy, and the fact that BC/BS is struggling largely due to the cost for services at our hospitals.”
Progress will be hard, according to Cordes, who noted the healthcare system’s many diverse players — which include a federal government that controls a lot of the funding but isn’t always on the same policy page as the Green Mountain State.
“We’re working hard to try to move a huge ship while it’s moving full speed in one direction,” she said of the complexity of the chore.
Will Vermonters see any progress toward healthcare reform this year?
Don’t count on anything major, Cordes said.
“I think this year we’re going to be doing the best we can to shore up some potentially failing institutions, and try to keep the healthcare ship from sinking,” she said. “I doubt this is the year for huge structural change. A bill for universal healthcare — which I support — is very expensive upfront to implement. We’re just not going to have the money to do that this year.”
Reporter John Flowers is at johnf@addisonindependent.com.
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