Top Democrats in the House and Senate say strengthening Vermont’s primary care system is top of mind this year, and they hope partly reviving an old payment reform idea could improve access.
A pair of bills in each chamber would re-introduce the idea of paying for primary care based on the number of patients served — not each individual visit or procedure. And they would also tell the state’s insurers to redirect more of their spending toward primary care.
About a decade ago, Vermont embarked on a plan to transition the state’s health care system away from a fee-for-service reimbursement model. But the experiment ran aground last year when OneCare, the entity meant to oversee the transition, shut down.
Proponents of this year’s primary care legislation say providers that participated in the reform effort actually did benefit.
“The goal is to kind of learn what we can from that model, not have it completely die on the vine with the closure of OneCare,” said Jessa Barnard, the executive director of the Vermont Medical Society.
Vermont is doing better than most states when it comes to access to primary care. Nine in 10 adults here report having a “personal health care provider,” according to a 2023 survey from the Vermont Department of Health. That’s higher than the 83% of adults nationwide who say they have access.
But the Vermont Medical Society says the state is currently short about 100 primary care doctors, and that this shortage is expected to get worse as providers age, retire and aren’t replaced. And for those trying to find a medical home, wait times are long.
“A lot of practices — 29% average — don't accept new patients, and the wait time is just horrendous. You know, anywhere between 60 days, up to 180 days. That's not good access," said Rep. Herb Olson, an Addison County Democrat and the lead sponsor of legislation in the House.
The bill he is sponsoring, as well as another backed by the Senate Health and Welfare Committee Chair Ginny Lyons, would set a target in state law that 15% of total health care spending in Vermont go to primary care. Both Lyons and Olson say they don’t want to increase expenditures overall, but instead redirect spending to a neglected and overburdened part of the system with a higher return on investment.
Vermont law already guarantees three primary care visits per year without co-pays. But both the House and Senate legislation would eliminate out-of-pocket costs for primary care altogether for patients insured by participating entities. Both bills also request reports from the state about the feasibility of eventually offering universal primary care in Vermont, with the Senate version contemplating a regional program.
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Vermont’s health care system is at a critical juncture. Residents pay some of the highest premiums in the nation, and the state’s largest commercial insurer is facing solvency concerns. President Donald Trump’s signature policy law could eventually cost the state hundreds of millions a year through cuts to Medicaid and other programs — although that same legislation will also bring Vermont a major short-term windfall for health care reform. State officials, meanwhile, are exploring a separate federal payment reform initiative.
Barnard said she believes strengthening primary care right now is deeply important. But she acknowledged she’ll have to win over skeptics who think Vermont already has enough on its plate.
“Everybody's very busy and at capacity, and there's a lot of change coming,” she said.
Gov. Phil Scott’s press secretary, Amanda Wheeler, said that the governor’s office had not yet reviewed the proposals.
