State legislators face health care questions

MONTPELIER — There are several big health care questions looming in this year's legislative session, but lawmakers acknowledge that they're still working to come up with answers.

Major issues identified by health care committee leaders include how to improve the state's mental health services; whether to create a universal primary care system; and whether to impose an "individual mandate" requiring Vermonters to obtain health insurance.

In each case, there's not yet a clear path forward. That's especially true when it comes to the mental health system, which has struggled to meet the state's growing needs.

Mental health "continues to be a really significant issue right now," said Rep. Bill Lippert, D-Chittenden-4-2 and chairman of the House Health Care Committee. "It touches every part of the health care system, really."

The Legislature in 2017 passed Act 82, which sought an in-depth analysis of Vermont's mental health system and recommendations for improvement.

The Department of

Mental Health issued an Act 82-related report in mid-December. But Lippert and Sen. Claire Ayer, D-Addison and chairwoman of the Senate Health and Welfare Committee, said they didn't see many concrete suggestions for changes in that document.

Both lawmakers said they expect more information to emerge in a second Act 82 report due this month and also in Gov. Phil Scott's budget proposal for next fiscal year. The Department of Mental Health's Jan. 15 report is supposed to take a closer look at facilities and whether treatment capacity can be increased.

"I'm hopeful that we will see more specific recommendations," Lippert said.

In the meantime, Ayer has sponsored a brief "placeholder" bill, S.203, that would enact an action plan submitted by the Agency of Human Services and also would "fund the construction of any facility necessary to expand access to mental health services."

The primary problem continues to be that "there are people who need care, and they're not getting it," Ayer said.

She said officials must find better ways to handle geriatric patients and forensic patients - those who are receiving mental health care due to their involvement in the criminal court system.

Ayer and Lippert also are concerned about the increased number of psychiatric patients who become stuck in hospital emergency rooms due to a lack of other treatment options.

"The hospital emergency rooms have been really, in some ways, the flashpoint for a lot of the pressure," Lippert said. Some patients have waited "for days and sometimes for weeks in emergency rooms, and they're not getting treatment," he added.

Lippert and Ayer identified several other health care issues that they expect to tackle in the 2018 session, which begins Wednesday:

- Universal primary care.

Ayer believes a publicly financed primary care system could improve health care outcomes while also saving money.

A bill she introduced in the first year of the legislative biennium, S.53, says "universal access to primary care will advance the health of Vermonters by preventing disease and by addressing Vermonters' health care problems before they become more serious and more costly."

It also says that, despite the need for more state funding, universal primary care would "reduce systemwide health care spending." The idea is that better primary care cuts down on the need for emergency room visits and inpatient hospital admissions.

But funding is an issue: The bill, which did not advance in 2017, required the Joint Fiscal Office to come up with "three tax financing mechanisms" for universal primary care.

One way or another, Ayer said, "this seems like a good investment - trying to figure out a way for everyone to have access to primary care."

- A Vermont individual mandate.

Recent congressional approval of a controversial federal tax code overhaul eliminates the federal government's individual health insurance mandate in the Affordable Care Act. State lawmakers say that could trigger a jump in insurance costs if many Vermonters drop their coverage.

"That's the basic tenet of insurance - everybody puts their money in a pool, and the people who need it will take some out," Ayer said.

Discussion of a possible Vermont mandate, however, is in its infancy. Lippert says state officials may look to Massachusetts for some answers, as that state has its own individual mandate that is unaffected by the federal repeal.

"There's much that can be learned from Massachusetts," Lippert said.

- The impact of federal budgetary decisions.

Lippert said state lawmakers must keep a close eye on continuing uncertainties about federal funding cuts for programs like children's health insurance and home health care.

"There's a whole host of fiscal issues that could have a big impact on Vermont," Lippert said.

- Prescription drug prices.

Lippert said he expects both the House and Senate health care committees to take another look at drug prices and "price transparency."

A proposed Senate bill, S.175, pitches a new program "to allow wholesale importation of prescription drugs from Canada into Vermont." It also would create "a bulk purchasing program for prescription drugs through the Department of Health and require prescription drug manufacturers to provide notice before introducing new, high-cost drugs to the market."

The bill also seeks more information from insurers about the impact of drug prices on premium rates.

- Reform of the state's electronic health information exchange network.

A recent report found that the patient record system, operated by Vermont Information Technology Leaders, is hampered by serious administrative and financial issues. Many patient records aren't in the system, and health care providers reportedly have "lost confidence" in the network.

"Our committee will take the lead on understanding the report and analyzing it," Lippert said. "There are some legislative changes needed if that's going to move in a new direction."

- Changes affecting the Green Mountain Care Board.

A proposed Senate bill, S.277, seeks changes to the certificate of need regulatory process followed by hospitals that are undertaking significant projects. The care board is looking for ways to 'streamline' that process.

Another bill, S.212, would require at least one member of the care board to be a "health care professional." There are no such members currently.

Ayer is in favor of that change. But Lippert has mixed feelings about it.

"We shouldn't have to have that in legislation," he said. "The governor had an opportunity to appoint a (health care) provider to the Green Mountain Care Board and chose not to."

Mike Faher can be contacted at


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