Vermont Legislature SmartTranscripts:

[Representative Alyssa Black (Chair)]: Hi, good evening and welcome to the public hearing on access to primary care. I am representative Alyssa Black. I am the chair of House Health Care and I just want to start with introducing the members of the committee and we're going to start over here. Hello everybody, I'm Leslie Goldman. I represent Windham 3, which is rocking him with sister number one.

[Representative Karen Lueders]: Good afternoon. I'm Karen Lueders, representative of Addison Ford at Lincoln Star Sparrow Marketing Bristol. Hi.

[Unidentified Representative (from Barre Town/Williamstown area)]: I'm David Sussie. I'm a representative from Barrytown in a slice of, Washington, Williamstown.

[Representative Karen Lueders]: Good evening, Tyler Taylor. I'm represent 11. That's Pittsfield, Carrollton, Belton, and Chittenden.

[Representative Alyssa Black (Chair)]: Again, I'm representative Alyssa Black, Chittenden 24, and I represent the Northern Section Of Essex.

[Representative Daisy Berbeco (Ranking Member)]: Good evening, everybody. I'm Daisy Berbeco, I represent my new state.

[Walter Carpenter]: This is loud.

[Liz Curry]: Those are so super loud. So

[Representative Alyssa Black (Chair)]: for this hearing, each person will have two and a half minutes to speak. Matt is going to run the witness timer, which is shown on the screen for you all. Representative Berbeco is going to call the name who is up immediately and then who also is on deck. If you're on deck, please be ready so that the testimony can proceed smoothly. If you're testifying on Zoom today, please mute yourself and keep your camera off while it is until it is your turn to speak, and when it is your turn to testify, you will be prompted in the webinar and then we'll be able to unmute yourself and turn your camera on and begin speaking. If this is your first public hearing, please note that our job as legislators is simply to listen to your testimony. We won't be asking questions during the hearing, so please don't take our silence as ambivalence. And finally, if your time is up, and you have more to say, we encourage you to please submit your written testimony as a PDF via email. I just wanted to round us and we have been working for several weeks taking testimony on the bill S197, which pertains to primary care. We've taken lots of testimony on this, but I think that it's really important and all of us are really excited and it's timely because starting tomorrow, we're going to actually start the process of putting thoughts and ideas and

[Representative Karen Lueders]: I'm excited that you're

[Representative Alyssa Black (Chair)]: the last people that we're going to hear, grounding us on why we're here, what we're trying to accomplish, and to make sure that your voice is heard in this process. So thank you very much for participating and welcome and representative Berbeco.

[Representative Daisy Berbeco (Ranking Member)]: First Brigadier from Angela Lawrence and Debra Hector, you'll be met.

[Representative Alyssa Black (Chair)]: Hi, Angela. Thanks. Go ahead.

[Angela Lawrence]: Hi. Good morning. Good afternoon. Good evening, everybody. Members, chair Black, members of the committee, my name is Angela Lawrence. I'm a resident of Brattleboro, Vermont. I am running today to RGFaun support for the establish of universal primary care system in our state. As we move past all pair experiment, we have unique opportunity to simplify our system and ensure that the front door of healthcare primary care is open to every Vermonter regardless of their ability to pay at the point of service. Primary care is a bedrock of a healthy society. However, for too many Vermonters, the cost of deductible or copay is a barrier that leads to delayed diagnosis and expensive emergency room visits. When it comes to financial predictability by transitioning to a fixed payment model as proposed in current legislation, we move away from the fee for service treadmill. This allows our local doctors to focus on patients rather than paperwork. When it comes to rural health stability in rural areas like my county, Windham County, primary care practices are struggling to keep their doors open. A new universal system provides a stable, predictable funding. These clinics need to remain viable. When it comes to long term savings, data from the Commonwealth Fund suggests that every $1 invested in primary care can yield up to $13 in total healthcare savings by preventing chronic illness from escalating into crisis. For example, last year, a neighbor of mine avoided going to their doctor for a persistent cough because they were worried about their $5,000 deductible. By the time they went in was advanced pneumonia and a universal primary care model that visit would have been covered. The illness caught weeks earlier. With the 2025 sunset of previous reform models Vermont's healthcare system is at crossroads. We are seeing rising premiums and a workforce shortage that is burning out our providers. S197 represent a necessary shift toward health equity. Universal access ensures that a farmer in the Northeast Kingdom and a tech worker in Burlington have the same foundational right to see a doctor. I ask this committee to prioritize the health of Vermonters over the complicity of insurance billing. Let us make Vermont the first state in the nation to guarantee that primary care is a public good, not a private luxury. Thank you for your time and for your service to our state.

[Representative Alyssa Black (Chair)]: Thank you, Linda.

[Molly Gray]: I feel like it's speed dating or something.

[Representative Daisy Berbeco (Ranking Member)]: Constant times. Constant state, you're gonna be nuts.

[Dr. Debra Richter]: I want to thank the chair and committee for having this testimony today, we're hearing today. My name is Debra Richter. I'm a family physician and addiction medicine specialist. I see patients every day that are dealing with this problem in our healthcare system, but everyone agrees that primary care is vital and we need to invest in it. Decades of research have shown that when people can actually get to primary care their health improves and costs drop overall. We're talking less use of the emergency room, lower infant mortality, quality improves, and people live longer. This isn't just an opinion. These are the facts. Investing in primary care is a huge return on investment. So the real question isn't if we should invest, but where we should start. Some people suggest we should begin by reforming the delivery system, assuming the savings will eventually let us expand coverage, sort of like a trickle down economics idea. I disagree. The quality and cost improvements we're looking for rely entirely on access first. If people can't get in the door, reform won't work the way it's supposed to. That's why we have to start the investment with access. We need to get everyone through the door. When we catch and treat diseases earlier, we reduce complications, and costs naturally fall over time. I'm strongly urging you to prioritize publicly funded primary care access for all Vermonters. Chair Black seemed to agree when she remarked recently when the committee was taking testimony on S197 that the best solution is the state covering the cost of direct primary care for everyone. I completely agree with that. We spent decades trying out pilot programs and small reforms, but care is still too expensive and too hard to get for too many people. Look at other countries. Universal publicly funded systems are actually what make health care more affordable. Here in Vermont, after twenty years of focusing on delivery reform, what have we seen? We've seen a dramatic erosion of primary care workforce, insurance costs are soaring, and patients are shouldering more of the costs. A 2025 survey done by the state showed that twenty nine percent of Vermonters are underinsured and eleven percent are completely uninsured. For too many, high deductibles mean their coverage is basically useless, so they put off or skip care altogether. The sad result is worse health and shorter lives. These problems are only going to get worse, especially with federal policy changes expected to kick even more Vermonters off coverage soon. It makes us wonder, what's the point of reform if patients can't even afford to walk through your door? Access is the absolute foundation for quality, efficiency, and controlling costs. If we want to improve everyone's health and finally get costs under control, we have to start with accessible primary care. You have a real chance to change all of this. I respectfully urge you to add an amendment to S197 to include a study on financing and an operations plan for a universal publicly funded primary care system for all Vermonters. By putting access first, Vermont can finally build a stronger, fairer health system for everyone. Thank you.

[Representative Alyssa Black (Chair)]: Thank you, Debra.

[Representative Daisy Berbeco (Ranking Member)]: Larry comes to the statement. And Howard Dean, you will be next. Go ahead, Larry.

[Dr. Larry Constantine]: Hi. Name is Larry Constantine. I am a physician who lives in Weitzfield in the Mad River Valley. I'm relatively new to this area, about twenty five years. I still think of myself as a Flatlander. My approach has not been to focus on the global issues associated with the benefits of primary care. I completely agree with the first two speakers. This is clearly the way to go, provide access to care and provide care that is affordable. I thought I would talk a little bit about an anecdote in our local community. We had a, I met something called the Mad River Health Center. And we had at 1.3 good physicians who are really dedicated to be here. Over the years, we've done many good things in the in the during COVID. We provided testing and immunization programs. It was really working well and it provided local care to local people. CVMC ended up taking over. We ended up losing our our site. They shifted care from Waitsville to Waterbury, which as you may know is gonna be a significant problem for low income families and families with limited with with limited transportation and certainly now with the high gasoline costs, it's gonna be even more difficult for people to get to Waterbury. Waterbury is a great site. They've got good physicians there but realistically, they're not handling the load as well as they could. So many individuals are trying to get appointments, but they're unable to get it. We tried to help. There were community meetings. We looked for some data. We were unwill they were unwilling to provide any financial data so that we couldn't approach any other practice or any other source of funding and we were sort of stuck. Just as an an aside, we have a we have a son who's a primary care physician who recently, graduated from his residency. He wanted to work in Vermont and he was unable to find a place where we were considered sufficiently underserved to repay his public health service loans. So we have physicians who are looking to work here and unfortunately, there are impediments. The other piece of it that was really frustrating was that we had, interacted with the Green Mountain Care Board. That is a convoluted, opaque entity and I was unable to do that. I'm a physician. I should know this stuff and I couldn't get through it And they were nice. It wasn't like they were mean. So anyway, I think there are problems that are remedial, not global healthcare for everyone, which is should be, but orally simple solutions that we can work on.

[Unidentified Committee Staff/Facilitator]: Thank you, Larry.

[Representative Alyssa Black (Chair)]: Welcome, Governor Dean.

[Unidentified Representative (from Barre Town/Williamstown area)]: Thank you. Sorry.

[Representative Daisy Berbeco (Ranking Member)]: My

[Governor Howard Dean]: biggest challenge as governor was universal health care. Governor Cina had started a program called Doctor. Dinosaur, which allowed children under the age of five and pregnant women to get health care if they qualify for Medicaid. We were able to expand that program to include all children 18 in the state of Vermont who were below 312% of poverty, which means essentially universal health care for everybody 18 has been in Vermont for thirty three decades. I run into young people all over the country on my travels who are from Vermont and tell me how much it meant to them growing up for them and their parents to have health insurance. Since then, we've made little progress. While care has gotten much more sophisticated, the expenses have gone up at three times the rate of inflation for more than thirty years. While insurance companies have greatly enriched themselves, outbursts, Vermonters have been driven into near poverty or worse by health care expenses. It's time after thirty years and multiple failures at change to say enough is enough. We are not going to reform the entire system in one year, but we have to stop making past failures and fears an excuse for doing nothing. The first and easiest step is to make primary care universal and free. This is already true for Vermonters 18 for thirty years. But this time, we're gonna pay the bills, not the federal government. This is urgent. Our primary care system is collapsing. One of the consequences is that people are not seeking care because they can't afford it, which makes the ignored medical problems literally millions of dollars more expensive later on. To say there's not the money to do this is simply false. The federal government cut taxes for me and thousands of Vermonters like me last year. That is Vermont money. That is not federal money that they are giving away. I would gladly pay what I paid last year in taxes if the money were used in Vermont to help my state regain our fit foot fitting, putting, and fix our eroding health care system, but I would only pay that extra if I knew that it would help Vermonters and not build ballrooms or fun monuments for vanity in Washington, DC. The American health care system gives great care to an increasingly smaller portion of our population who can afford it. Middle class Americans are increasingly going without health care. We can seize this moment and be an example for the rest of the country, or we can allow past failures to dissuade us from doing anything about this. This is the first step, but it's the least expensive and the most likely to make health care more affordable for ordinary middle class people. Poor poor people are reasonably well taken care of because of Medicaid, which is very generous in our state. Poor people I mean, middle class people are the people that needed the help. This is a middle class problem, and it can be solved not with spending more money, simply with pulling back the money from the federal government, which went to people like me and having us spend it on health care.

[Molly Gray]: Thank you, governor.

[Unidentified Representative (from Barre Town/Williamstown area)]: Thank you, governor.

[Representative Daisy Berbeco (Ranking Member)]: Melinda Molson. And on deck, Mike Palmer.

[Melinda Molson]: Good afternoon. My name is Melinda Molson, and I support primary care for all Vermonters. Imagine a person diagnosed with a debilitating illness or disease. She works for a company that offers health insurance with a $6,000 deductible. She chooses to postpone seeing her primary care physician because of the out of pocket costs. Her health deteriorates. At 65, she enrolls in Medicare and purchases a supplemental insurance policy which also has a high deductible and she avoids going to her doctor. Without her physician's care she becomes so sick that she is hospitalized and requires very expensive treatments and tests. Primary care is the first step in keeping us healthy. It is the once over that guides our goals for living a healthy lifestyle. Primary care is preventative care. They are the physicians who refer us to specialists and determine the next steps for our care. So many of us forego preventative care because of the costs, lack of insurance, and fear of further medical referrals that may cause extreme financial hardship, either bankruptcy. Free primary, or as I like to say, preventative care, will support our healthcare system's economic model. Detecting and addressing medical issues early in a patient's care will help reduce overall health care costs for the entire system. 46% of Vermont's medical care costs are hospital related, 46%. Keeping patients out of the hospital is smart economic policy and with early primary care reducing hospital visits is probable. Insurance costs are skyrocketing. Nationally, the administrative costs charged by health networks and insurance companies are 25% of the nation's total health care costs. The administrative costs by insurance companies are 25% of the nation's total health care costs. Vermont has one of the highest health care crisis in the country. Primary preventative health care for all is a win win for everyone, the people and the health care system, and we can do this for mine. We can do this for mine. Thank you.

[Representative Daisy Berbeco (Ranking Member)]: Mike Palmer, you're next, and Julie Adams, be ready.

[Mike Palmer]: Good afternoon and thank you. My name is Mike Palmer, I'm from Cornwall, and I want to tell you a couple of stories. My story first, I've had good primary care for over three decades, and because of it, I'm alive. If I didn't have it, I probably would be either dead or disabled because my primary care physicians diagnosed and detected early several problems along the way that needed attention and because I got attention and got the prevention that I needed, I'm sitting here before you right now. My brother's story is different. My brother lived in Benson, he was a special education advocate and he was like many of his clients, very poor. He could not afford to see a primary care physician and didn't. And because of that, one morning he woke up with a urinary tract blockage, emergency vehicle took him to UVM, he spent a week in the hospital there, and over the next three years, he slowly declined as various organs collapsed and he eventually died. And I believe all of that would have been prevented had he had early detection of some of the problems he had by visiting a primary care physician. His story is the story of many other Vermonters, and the possible story of 188,000 Vermonters who are under insured right now. They don't go see a primary care physician because as governor Dean and others have said before me, they can't afford to. And because they can't afford to, they don't get early detection of hypertension, of pre diabetes, of other diseases that when they become chronic or severe or acute become life threatening and require expensive care. Some of them will get very sick and require that expensive care, they'll go to the emergency room, others will die, and they will die prematurely, painfully, and expensively, and their deaths are absolutely preventable if we have universal primary care. I urge you to put the funding in place for a study, a financing study, part of S197. Thank you very much.

[Representative Alyssa Black (Chair)]: Thank you, Mike.

[Representative Daisy Berbeco (Ranking Member)]: Julie Adams. And Liz Curry, you'll be next.

[Julie Adams]: I'm still muted. Sorry, I just realized I was still muted. Go ahead, Julie. Hi everyone. Sorry for getting a little bit mixed up there with getting things started. My name is Julie Adams. I am a lifelong resident of Addison County and a licensed physical therapist. I have been a practicing physical therapist for the last thirty five years and I live in Addison County and I have been in the town of Ferrisburg for the last twenty three years. I'm here representing the American Physical Therapy Association in our Vermont chapter, but I wanted to give you a little bit of my own background because it's a really important piece of legislation from my perspective and from my values. I am the granddaughter of two Vermont state representatives, Herrick Spencer and Marion Spencer. When my grandfather died, my grandmother ran for his seat and took it over and was in it for fifteen years. I'm also the granddaughter of a primary care physician who practiced into his eighties in the state of New Jersey. I was initially licensed in Virginia after graduating from the University of Vermont with a Bachelor's of Science in Physical Therapy and Pre Med. I then moved on to become a physical therapist practicing at that level. I added a doctoral degree in 2006 to add some more research expertise to my practice. I have been a strong advocate for nonprofit and have only ever worked in nonprofit healthcare. I do believe in philanthropy and access ought to care as being one of our most important things that we do as clinicians. I served in a leadership role since 1994 in two different hospital systems, one in Virginia, and then for the past twenty three years, I was at the University of Vermont Medical Center. I retired in December 2025. The primary reason I retired was frustration with our lack of a system and with what happens to our patients when they are quote unquote insured, insured, but they're really uninsured. I needed to get out and be able to do more things on a pro bono basis and to just focus on clinical care and not on all of these financial constraints that limit our ability to serve our patients. As part of my role at the medical center, I was responsible for the inpatient rehabilitation unit for all the therapies provided there, as well as for outpatient programs focused on neurological conditions and on the most complex medical conditions. I will tell you, I've personally treated thousands of patients in the past thirty five years, and most of them have had preventable diseases or injuries or illness. I want to just share one example that we did do at the medical center that I thought was quite helpful. Since 2003, at my urging, we were starting to take vital signs on every patient and we were able to catch strokes before they happened. We were able to notify primary care docs and patients of these needs and those things were able to be addressed. In summary, while this example is from my own experience, the American Physical Therapy Association and I personally fully support increased access to primary care. We would like to help if we could, but we're really most focused on getting patients access. So thank you for that.

[Representative Daisy Berbeco (Ranking Member)]: Thank you, Julie. Liz Currie. And Sebastian Murray will be next.

[Liz Curry]: Hi, sorry for the delay. Go ahead. I'm Liz Curry. I'm a Burlington resident. Thank you for holding this public hearing. Thirty years ago, my husband and I paid about $3,000 and now we pay $7,500 for our annual property taxes, education property taxes. For $20 a day, our kids received K through 12 education that prepared them for top colleges. We're still happy to pay that amount in ed taxes because we know the outcome is Vermont kids who become decent, caring people participating in our economy and communities. That $20 a day covers 87% of the physical infrastructure and personnel costs delivering Vermont's education for thirty five hours a week to 83,000 kids so parents can work. Moreover, the average percentage increase over month's Ed property taxes over ten years is about 4.5 to 5%. By contrast, we pay $1,800 a month in health insurance premiums for two annual exams, two colonoscopies, one mammogram and routine vaccines each year. That's it. For $60 a day, we get four health care services once a year. For prescriptions and any other service, we pay a deductible up to $12,900 So our total health care costs can reach $34,000 a year. What's worse is our premiums contribute to only 52% of the physical infrastructure and personnel needed to deliver decent health care to Vermonters. Bills arrive from both the hospital and the doctor that cover multiple disparate but bundled costs, many of which embed the stranded costs of those who can't pay. Can you imagine a public health, a public education system that sent you multiple bills per kid for every class they take and how much attention they receive each day, with rates bundling the direct costs of the room, the laptops, teacher salaries and indirect costs of administrators and buildings? Can you imagine if those rates jump between 812% each year as Vermont's premiums have? This would be unacceptable and it should be unacceptable for health. We don't have a property tax crisis. We have a health care cost crisis. This session, I urge you to amend a bill to allocate funding for a data driven financing and operations plan for universal primary care. We've already socialized the costs of health care in these stranded costs and premiums. So let's make it a single payer universal primary care system to prevent Vermonters from going without health care. Thank you. Thank you, Liz. Sebastian Lueders, you're

[Representative Alyssa Black (Chair)]: up and Courtney Cunningham will be next.

[Sebastian Lueders]: Thank you. My name is Sebastian Lueders. I am the president of Higher Education of AFT Vermont. AFT Vermont has long endorsed health care as a human right, and we have advocated for Vermont to ensure access to primary care for all Vermonters. We represent over 12,000 health care and higher education workers across the state, a number that continues to grow. One of the most common needs identified at the bargaining tables across the state is access to affordable health care. It is a driving factor of all economic issues. This expenditure impacts businesses as much as individuals. Businesses would save on premiums, yes, but also see more revenue from residents no longer having to choose between a trip to the store or ensuring their health. In my union roles, in my role as an employee of the Vermont State College System, and as a citizen of Vermont, I know and I see the myriad of Vermonters that live paycheck to paycheck, who put off needed care because they have to choose where to spend their money, who are one bad injury or illness from losing everything they've worked for. If we were to decouple health care from employment and guarantee it as a right to all people, paid for through taxes according to ability to pay, Individual budgets and businesses' budgets would have much more flexibility to pay for other important things, such as putting that money that they would have spent on health care toward buying homes, ensuring access to day care, affording higher education, and from the business side, higher wages to attract the quality of talent this great state has. Ensuring access to affordable health care would give Vermonters the financial freedom and flexibility that would improve the lives and livelihoods of individuals, families, businesses, local communities, and the state of Vermont. Thank you.

[Representative Daisy Berbeco (Ranking Member)]: Thank you, Sebastian. Courtney Cunningham and Matt Giles, you will be next.

[Unidentified Committee Staff/Facilitator]: Courtney joins, then let us know and we can move in.

[Representative Daisy Berbeco (Ranking Member)]: Want to go to Matt Giles? And then Ellen Auxfield will be after Matt.

[Representative Alyssa Black (Chair)]: Hi. Welcome, Matt. Go ahead.

[Matt Giles]: Hi. Thank you. Yeah. I'm Matt Gyle. I'm a school librarian and a resident of Onewski. Health care affordability and access in Vermont is currently in crisis. The impending cuts to Affordable Care Act subsidies and tens of thousands of Vermonters losing Medicaid is going to be devastating for those losing that coverage. But the strain of so many people losing coverage is going to have ramifications throughout our system. And no one will be insulated from that harm. Having insurance can help you if your primary care physician leaves or the nearest hospital closes. The obvious solution is universal single payer nationwide healthcare, but we can't wait. Vermonters will die without access to care and the damage to our healthcare system could take decades to repair. Incremental fixes cannot begin to meet this crisis. This bill must guarantee universal access to primary care and we've heard so many things and reasons about why that's so important and vital for our health. And only that universal access to primary care will be a step forward. And it can demonstrate what is actually possible when we decide to prioritize caring for each other. So thank you very much.

[Representative Alyssa Black (Chair)]: Thank you.

[Representative Daisy Berbeco (Ranking Member)]: Ellen Oxfelt and Dee Henry will be next.

[Ellen Oxfeld]: I'm a resident of Middlebury and I've advocated for years for healthcare as a public good in the state of Vermont. I've never understood how we can allow access to something as necessary as health care to be based on something like ability to pay or means testing. No one in the future will understand this injustice. I do not have a personal health care story to tell because I'm one of the loved ones. I have a personal and primary care provider and enough financial resources that out of pocket cuts do not deter me. But this is not the case for so many Vermonters. We know one hundred and eighty seven thousand eight hundred Vermonters were underinsured in 2025. They delay care until their conditions are worse and more expensive. And that shows the necessity of universal primary care. But I would like to add today that we don't need to argue for the necessity. You know it's necessary. The question is, how do we get there? Okay, we can achieve universality and cost control with a publicly financed universal system. Means testing creates administrative burdens and inevitably leaves people out. And trying to sculpt private insurance to our will creates Byzantine complexity. We have tried reforms based on private insurance for several decades. There is no reason to think it will be different now. And finally, there's another reason. We need primary care as a publicly financed universal good. Universal programs create solidarity as opposed to resentment. Think about this. Americans love Medicare and Social Security because we all pay in according to our means, and then we all get something in return. That is what we need. That's why we say everybody in, nobody out. We can find a way to finance this fairly and equitably, which adheres to the principles laid out in Act 48. But there is no way to finance this when we are relying on umpteen different private insurance plans with their different rules, co payments, deductibles, and the complexity this creates. A universal publicly financed primary care system will be better for providers, saving paperwork and allowing them to do what they want to do, care for patients. So let's take a small step forward. Let's attach an amendment to S197 that will get cost estimates for current primary care in Vermont and then create a commission to recommend an operational and financing plan for universal publicly financed primary care. Yes, there's some wonky details like waivers, but that's why we need to get the study done. Let's not wait. Universal primary care is a step forward to the greater goal of healthcare for all, but it's an essential step. Let's get started. Thank you, Allen.

[Representative Alyssa Black (Chair)]: Patrick Kane. And we'll have Ethan Abbedonia Lawrence next.

[Patrick Payne]: Hello, and thank you for the time this evening. I'm Patrick Payne. I'm a first year medical student at the Larner College of Medicine. And for the past year, I've been learning about the complexities of human anatomy. And despite all of that, I've found that the complexities of our health care service system and insurance to be wildly more complex. I recognize that the complexities of the bodies are where a lot of the beauties lie in life, and I think we would all not find that the health insurance system has those same beauties. I'm advocating for everybody to step forward and imagine a future that's free of these complexities, these complexities that leave an overwhelming of our community members to fall through the cracks of a system that's difficult for both health care providers to navigate demanding greater amounts of administrative loads, but is also incredibly difficult for patients to navigate. With so many people coming to our offices not knowing exactly what they'll be able to get coverage for or what they'll have to fight tooth and nail in order to get the services that their clinicians say that they needed. Earlier today, I found myself in an outreach clinic where we met our community members at the food bank where they were helping to provide antibiotics that they needed so that they could avoid going to their emergency room and bringing on even greater costs. These are opportunities that are afforded to us because the clinic that I'm helping with and learning from is free of a lot of the burdens that traditional health insurance models offer. I think that this model of primary care is something that we can all imagine as a future that we would like to be patients in, whether it's being there as patients, being there with our family members who may one day find themselves in the same position. So I ask of you as a future Vermont physician and future primary care provider to think of a future that is free of the complexities so that we can care for each other the way that we really desperately want to. Thank you for your time.

[Representative Karen Lueders]: Thank you, Patrick.

[Representative Alyssa Black (Chair)]: Next we have Ethan Avenden, Laurence and Shasta Fowler will be next.

[Ethan (Licensed Clinical Social Worker)]: Hi. Hello. Can you hear me?

[Representative Alyssa Black (Chair)]: Yes. Go ahead, Ethan.

[Ethan (Licensed Clinical Social Worker)]: Nice to meet you. Thank you. My name is Ethan. I'm a licensed clinical social worker in the state of Vermont and the state of New Hampshire. I've worked with families for over ten years in child welfare and currently work in substance use disorder treatment. I worked with in home with families all around the state of Vermont in every corner. Universal primary care is important, and universal health care in and of itself is crucial because it's a proactive measure and not just a reactive measure. It's not just about saving cost proactively, but it's about changing cycles of hereditary trauma ahead of time. We are in a pan an epidemic of isolation and loneliness without this country, and diseases of despair for Vermonters are doing incredible damage to family systems, to children who are under the age of four, who watch their parents suffer with anxiety and depression, and it impacts their ability to attach and therefore be able to trust people later on in life and maybe turn to substances themselves. Connection we know heals. Psychosomatic symptoms from hyper hyperarousal and panic attacks to hypoarousal and depression. A connection in and of itself is a level of intervention. We, as human beings, are wired for connection, and then we know it heals. But it's not just therapists that do this. It's nurses. It's doctors. It's medical assistants and admin assistants. Shame, I think, is the currency of oppression because it convinces people that they deserve to suffer and to and their and teaches them to be complacent in their interpersonal and systemic abuses that they suffer. When I treat adults, I'm also treating the families. We need to get a chance to help these families heal before they stabilize. We need to catch these diseases of despair while we can still heal them with connection and not further overpowering interventions. Thank you.

[Representative Alyssa Black (Chair)]: Thank you, Eva. Shasta Fowler, and next we'll

[Representative Karen Lueders]: hear

[Unidentified Committee Staff/Facilitator]: financed and assuming. So we have a health care system where everyone is in and no one is left behind. We've been stalled for fifteen years. We've delayed care to our system, all the while spending money on remedies that did nothing but waste time and money. As a voter, mom, and caregiver, I demand a course correction in how we fund our health care system, fulfill the promise of Act 48. Thank you, Chats up, Kate.

[Representative Alyssa Black (Chair)]: Anna King. And next, we'll jump from Kate Tian. Okay, so let's go to Kate. And next will be Anna Carey.

[Dr. Ke Tian]: Hi, Katie. Hi. Good afternoon, everyone. My name is doctor Ke Tian. I'm a board certified family physician at the community health centers in Chittenden County. I completed my residency at UVM last year. I practiced what I called womb to tomb medicine, caring for patients of all ages, including obstetric care, right in our clinic. In my practice, physician turnover has been high. Our patients bear the cost. People with chronic conditions come in and meet a new provider again. History get reconstructed from scratch and screenings get lost. Patients with a consistent primary care physician have health care costs 27% lower than those without one. When we lose a physician, those patients don't disappear. They go to the emergency department at five to eight times the cost of office visit. I want to address something directly. It is not about the size of a paycheck. What matters to me is practice medicine that I'm proud of, medicine that adds real value to the community. That means team based care that includes mental health counselors, clinical pharmacists, community health workers in our clinic. It means being able to sustain prenatal care and pediatric visits, services that this community cannot do without, but does not pay well. It means being fairly compensated for the work that never shows up on the billing statement, the overnight calls at the hospital for pregnant patients, the time spent teaching the next generation of physicians, the hours lost to prior authorizations that have nothing to do with patient care, and also adequate wages to keep our nurses, medical assistants, front desk staff from turning over constantly. When the environment erodes, physicians don't leave with bigger paychecks. They leave to find a place where they can practice medicine worth staying for. That is why Vermont is losing physicians, not just to higher paying states, but to direct primary care and concierge medicine, because that gives them back the practice they go into medicine to do. My husband and I came to Vermont for UVM's excellent training, and we want to stay, but my husband carries significant student loans, and Vermont's loan repayment program does not compete with neighboring states. And challenges in our practice right now is making it harder every month to commit to a future here. I did not go into family medicine to make a big paycheck. I want to practice medicine that I'm proud of, and care for patients who need me. Right now, Vermont is making that harder than it should be. I'm asking this committee to support S197's primary care investment provisions and to expand Vermont's physician loan repayment program to be regionally competitive. Retaining a trained family physician costs far less than absorbing what happens when they leave. Thank you and I'm happy to answer any questions.

[Representative Alyssa Black (Chair)]: Thank you, Kate.

[Representative Daisy Berbeco (Ranking Member)]: We're going hear from Anna Carey and Molly Grave will be after that.

[Dr. Anna Perry]: Thank you. My name is Anna Perry and I'm from Burlington. I'm a family doctor, first with UVM for many years and then rural Cambridge Vermont. Let's face it, primary health care does work. As a family physician, I know that access to timely care is essential. Example, a 30 year old man slices his finger on a wire fence, no insurance. So he sews his wound after cleaning it with dental floss. Four days later, his finger and hand are red, swollen, and painful. He comes to my office scared. The dental floss has come undone. We remove it, clean the wound, frequent dressing changes and antibiotics all fortunately save his finger and hand. Now a personal story. As a patient with type one diabetes for forty five years, my family nurse practitioner recently saw me urgently for a toe wound. She ordered x rays which showed the toe bone was infected. She has started six weeks of antibiotics, saving me from a toe amputation. We all need access to primary care, farmers, doctors, teens, or elders. House Bill four thirty three introduced by representative Brian Cina, a active member of this committee, would legislate publicly financed universal primary care. Age four thirty three would provide every Vermont resident with comprehensive primary care without premiums, deductibles, and co pays. By reducing administrative costs and focusing on prevention, university primary care helps control healthcare costs that are driving up school budgets and property taxes. Incremental changes are not working. One care ACO went belly up after six costly years. State auditors just recently testified that the Blueprint quality improvement model provides no taxpayer savings. And can anyone explain what broader reference based pricing really means? Invest in primary care now and save lives and money by treating people before their conditions become more serious and costly. Thank you for your time and consideration.

[Representative Daisy Berbeco (Ranking Member)]: Thank you, Anna. Molly Gray, and next will be Lance Roy.

[Molly Gray]: Thank you for your leadership and for the opportunity to speak on access to primary care in Vermont this evening. I'm here today as a taxpayer, a mom, a caregiver to my mom, and as a candidate for Lieutenant Governor. Over the last several months, I've heard from hundreds of Vermonters about the cost of living, health care, and education spending. I'm here to amplify some of those concerns and explain why I strongly support universal primary care. Earlier this month, I met with the Hartford Professional Firefighters. One of the largest expenses and most frequent calls for emergency services is transporting patients to the emergency room for health issues that would otherwise be addressed through primary care. At a recent school board meeting at Hartwood Union High School, the district shared that health insurance premiums rose 35% over the last three years. And as this committee knows, these premiums have become the largest driver of education spending and in turn property taxes. But closing schools and consolidating districts does not address health care costs and does little to truly stabilize property taxes, which fall most heavily on working Vermonters. To put it bluntly, not only is Vermont placing a failing system on the backs of our children, but also failing to deliver on a basic human right. We know investments in primary care and preventative care work. Consider Doctor. Dinosaur, and we heard from Doctor. Dean earlier. For more than thirty years, Vermont children 19, as well as pregnant people and those parents after pregnancy, have been eligible for low cost or free health coverage. This has kept kids and new parents healthy and out of the emergency room. Consider the Osher Center for Integrative Health, where preventative care for Vermonters experiencing chronic pain includes conventional and complementary treatment with an emphasis on the whole person. Patients have experienced a seventy percent decrease in emergency room visits one year out from treatment. And consider what is happening in my hometown of South Newbury, where Little Rivers Healthcare, whose mission is affordable care for all, has adapted its practice to meet patients where they are. They conduct home visits, so Vermonters like my mom, who has multiple sclerosis, can easily access quality care when a trip to the clinic is physically impossible. I don't have all the answers, but I know we have tremendous talent in this room, this committee, and across the state. I encourage the committee to act on S197, but also to consider the urgency of the moment and to consider a task force mandated to urgently develop a universal primary care plan and a timeline for deployment. I will continue to take every opportunity to work with this committee and the legislature in the months and years ahead. Thank you again for your leadership and the chance to speak.

[Representative Alyssa Black (Chair)]: Thank you, Molly.

[Matt Giles]: Thank you.

[Representative Daisy Berbeco (Ranking Member)]: Lance Broy and Michelle Thurwat will be after that.

[Dr. Lance Broy]: Yes, hello everyone and thank you for the opportunity to speak this evening. Honestly, lot of what I was going to speak to has already been spoken. Been amazing comments that's been delivered thus far. I'm going to focus on workforce development. I feel in terms of access from a physician perspective, I am a physician and CEO the county federally qualified center. And the first moment issue I'd like to focus on is the main amount for a month for a residency program. This being suggested we have received accreditation, and now we just need funding that programs primarily would be based at the partners of the county and different health center in Orange County. That would give us an opportunity to train residents in rural settings, our only family medicine residency program and that UBM. And you know from data that residents tend to stay where they train and with the systems that they know, the health record and the referral patterns, if we could train physicians in rural areas, we could more likely retain them. Primary care services are some of the lowest paid services in the country, but yet save us the most healthcare dollars. So we have to invest in primary care to reach the rewards, saving the people go along with that, and especially in rural areas, we have to get providers trained in those areas, stay in those areas to provide that primary care and save the health care dollars for the overall system. We do live in a fee for service world primarily. We need to understand that primary care providers provide services outside of that fee for the service of the visit. We work with home health agencies, with the emergency departments, with the hospitals. We take calls all the time and follow-up with patients outside of the primary care visit, and so we need to invest in ways to compensate providers for that work they do outside of the direct patient care visit. The last thing I'd mention is burnout. Primary care providers particularly are overworked and underpaid and again investing in those services allowing them not to feel reports have been paid as a primary initiative we also. I thank you for your time.

[Representative Alyssa Black (Chair)]: Thank you, Lance.

[Representative Daisy Berbeco (Ranking Member)]: Michelle Durbar and Representative White will be after that.

[Dr. Michelle Dorwart]: Hi, thank you. My name is Michelle Dorwer. I'm a family physician and I practice at the Community Health Centers in Chittenden County with Doctor. Tian, who spoke earlier. I'm an example of what doctor Broy was talking about. So I came to Vermont for my residency training in 2013, not anticipating staying in Vermont, but ultimately fell in love with the state and did stay after residency, and and have been working at the community health centers since then. I'm a third generation family physician, and two of my three brothers also are family physicians working in Nebraska, which is where I'm from. When I came to Vermont, the state was really planning to embark upon the single payer system, and so I was really excited about that prospect and being part of this new type of system. I was disappointing when the decision was made not to proceed with that system with the expectation that it would be too expensive, but I would argue that it was too expensive not to embark on that system. And we've spent billions and billions of dollars that could have been saved by going forward with a single payer system. So I'm really excited about the prospect of this bill and what it could mean for our patients and for our communities. As a family physician, I you know, we spend a lot of our time doing things outside of clinic visits, but the only time that we're compensated is during clinic visits. It's so often that we would love to be able to just, like, provide our patients the care that they need without having them come in. Certainly, sometimes they need to, but many times it would be very useful to be able to just, like, call in a prescription, you know, do a lot of things outside of the visits. But the way that we're compensated is to have people come in for visits. And so that just working in that sort of fee for service system for primary care, I think, just is not the best way. And I know that there is just so much focus on on budget. Of course, it's so important when we think of our school budgets and and constantly kind of having to to increase how much we're paying for our schools, if we really think about why that is the reason for our school budgets going up is because teachers need health insurance, and health insurance rates are increasing. So the way to address that is really to address the cost of health care. And truly, we know that access to primary care is something that improves health outcomes and also reduces costs to the system. So I really think that I'm excited about this possibility, and I am hopeful that Vermont can move forward, with this of universal primary care, I think it be a major way for us to lead the country. So thank you. And thank you to everyone who's testifying. I'm really impressed with all the testimony this evening.

[Unidentified Committee Staff/Facilitator]: Thank you, Michelle.

[Representative Daisy Berbeco (Ranking Member)]: Representative White and Nathan is

[Representative Candice White]: on deck. Good evening. My name is Candice White. I represent the towns of Warren, Wagefield, Phase Ten, Moor Town and Duxbury. I'm speaking on behalf of my district, which lost a primary care facility, Mavamore Family Practice, in late twenty twenty five due to cuts by UVM Health Network. The Mavamore Valley Health Center had operated a primary care practice in Wakefield since 1981. The practice was designated as a rural health clinic in 1996, serving all patients, including Medicare and Medicaid. In 2016, upon the retirement of one of the doctors, the practice was sold to several Vermont Medical Center. Eight years later, UVM Health Network, which includes CVMC, announced the impending closure of Madder River Family Practice. This was a top down decision by hospital administration without input from those affected, not from doctors and nurses working there, nor the board, nor the patients. We know that access to primary care lessens the cost of healthcare by offering preventative care and treatment of ailments before they require hospital care. We know that hospital level care is the most expensive care, yet we are closing primary care practices across Vermont. My community requests that when a healthcare provider contemplates closing or reducing services, there must be a clear and open procedure similar to the certificate of need process. When CBMC announced the closure of our practice, the decision was non negotiable. This process must not be repeated. My community further requests the public disclosure of operating expenses and revenues when a healthcare facility is contemplating a change or closure. UVM and CBMC are non profits and while they disclose their tax returns, that information is high level. Specifics were needed to truly understand and possibly remedy our situation, and these were not provided. A practice that had thrived for thirty five years was purchased and shuttered in roughly eight years. Currently a subset of staff from the former Matador family practice is operating a concierge style practice in Waysfield and this is a better outcome than an empty building, but our practitioners would like to serve all patients and not just those with means. Ours is a cautionary tale of what went wrong and as Vermont works to control healthcare costs and increase access to primary care, I hope you'll think about this. Thank you.

[Liz Curry]: Thank you, Candice.

[Unidentified Representative (from Barre Town/Williamstown area)]: Thank you.

[Representative Alyssa Black (Chair)]: Nathan Bacon and Joseph Naska will be at the.

[Representative Daisy Berbeco (Ranking Member)]: Nathan here?

[Representative Alyssa Black (Chair)]: Are you Nathan?

[Dr. Joseph Nasca]: Thank you for all the time and spending with this. I'm a primary care physician. I'm a pediatrician. I graduated from UVM Medical School in 1988 and I'm the Health First representative, which is a private practice organization to the Vermont Steering Committee for Comprehensive Healthcare, which you know about. I have been practicing for thirty five years now in Franklin County. I worked the first fifteen years with a big group and we went from four to eight docs, five offices, 30 staff. I got very confused. The patients were very confused. So I decided to go off and do solo practice, which everybody thought it was crazy. Eighteen years I was in solo practice in Georgia, cared for about 2,000 patients. I was available 20 fourseven to my staff, to my patients, thanks to the great staff that I had, my wife and children. The last two years, I've been employed by Georgia Pediatrics partner, Mike Viskor, who graduated from UVM in 2012, took over for me. I was trying to figure out something worth saying here today. A lot of good things have been said. Our state motto is freedom and unity. And for some of us, practicing in solo model in a small practice is really important. It was for me. We look at the blueprint several times. It says, you're doing everything right, but you gotta document it all. And the the cost, the implementation costs and burdens, I think that's what's driving the burnout for a lot of doctors. I like to be available to my patients, and they treated me very well. It was harder to be on call every night, or it was harder to be on call once every eighth night than it was to be on call every night for my patients because it kind of protected me a little bit, but they knew they could always get uphold. A small rural practice feels a lot more like a small rural dairy farm or a small local market. The small practice becomes part of the community and it's part of the fabric of the community. For me, the autonomy around my own practice, practice medicine the way that felt right for me, following the clinical guidelines and allowing for individual adaptation to unique patient needs has been so important. I really treasured my time as a physician. My neighbor, who's a dairy farmer, I asked him once when milk prices were down, how do you keep going? And he said, hope. So I hope that you can figure something out to allow what I did for the last thirty five years to continue. Thank you.

[Representative Alyssa Black (Chair)]: Thank you, Joe. I would also like to say that we tried to find a provider that didn't participate in the blueprint. We couldn't find one.

[Representative Daisy Berbeco (Ranking Member)]: Erica Bronze and Dan Barlow will be after that.

[Representative Alyssa Black (Chair)]: Hi Erica, go ahead.

[Erica Bronze]: Hi. Thank you for taking the time to listen to my perspective. My name is Erica Bronze, and I'm a 53 year old self employed worker living in Winooski. My family and I have fundamentally lost access to primary health care because we are some of the 9,200 Vermonters who lost their ACA tax subsidies for health insurance at the beginning of 2026. As it now stands in Vermont, in a good year where only one family member meets their deductible, a family of three making a $130,000 a year will pay a minimum of $35,000 a year in premiums plus one deductible before any health insurance benefits kick in. This is 27% of their income. If it's a bad year, meaning all three family members meet their deductibles, they will pay $47,000 before any health insurance kicks in. This is 36% of their yearly income. How much of a family's yearly income is reasonable to pay for health insurance? We are willing to pay our fair share, but 27 to 36% of our income is impossible. After a great deal of research, I was able to find and enroll in a catastrophic care plan where our premium is $13,200 a year and our deductible is $21,500 However, this still means that we are woefully underinsured. Even though we pay our monthly premium, we will not see any insurance benefit until we reach our $21,500 deductible. How are we supposed to afford to go see a physician where we'll have to pay out of pocket for the visit and any labs or procedures that we might need? We are struggling just to pay our premium. We are avoiding going to the doctor for any reason. We are not alone in this decision. There are thousands of us who wrestle with impossible choices. How bad does a symptom need to get in order for us to overcome the financial barrier to receive care? It's a tricky thing to self monitor, and without medical training, how are we supposed to make such decisions? This type of financial uncertainty is exactly what leads people like us to forego regular primary care. It is well documented that access to primary care greatly reduce costs and improves health outcomes across the board. Small problems are addressed before they become bigger, more costly and life threatening problems. Healthcare is a human right. We need to do better. I urge you to pass legislation that makes primary healthcare available to all of us. In the end, this will bring costs down, improve outcomes and save lives.

[Dr. Ke Tian]: Thank you for your

[Representative Alyssa Black (Chair)]: Thank Erica.

[Representative Daisy Berbeco (Ranking Member)]: Thanks Erica, good to see you. Dan Barlow and Nicole DeVita will be after that.

[Daniel Barlow]: Good evening committee and thank you for the opportunity to speak. My name is Daniel Barlow and I serve as the executive director of the People's Health and Wellness Clinic in Barrie. And I'm here tonight to join my friends, neighbors and colleagues in support universal primary care. In many ways, what the free clinics are doing every day is a universal primary care system in action. Also want to thank the legislature for recognizing that the free clinics need to be strengthened. The budget is still in play, and we are hopeful that these investments will be finalized. But I want to be clear about what we're seeing on the ground right now. That's having insurance does not mean having access to primary care. At my clinic, many of our patients have Medicaid or Medicare. They are technically covered, but they cannot find a primary care provider taking new patients, or they face months long waits, or they cannot reward the out of pocket costs. So they come to us not because they're uninsured, but because the system has no available entry point. And this is a critical shift in what free clinics are doing. We are no longer just serving the uninsured. We are increasingly serving as an access point to a primary care system that is collapsing. The proposed funding to expand clinic hours is important. It'll help us serve more patients where we already are, but it does not serve a structural issue in the state. And that's geographic access to care. Based on what we're seeing at the People's Health and Wellness Clinic, I would offer one seed of an idea that could be a bridge towards universal primary care. And that would be having access to a free clinic hub in every county of the state. Expanding hours in existing sites will help, but it does not help the patient in another region who has no clinic, no provider, and no transportation options. This is not a fully developed proposal at all, and it would need to be shaped in partnership with communities and providers across the state. But directionally, it means building on what already works, supporting additional sites, partnerships, or even mobile models in underserved areas. Because what we know is that free clinics are one of the most cost effective entry points into the healthcare system. We reduce unnecessary emergency department use, we manage chronic conditions earlier, We connect patients to ongoing care when it's available. If Vermont is serious about primary care access, we need to fund it like infrastructure, measure it like a system and staff it like a team. Free clinics are already holding the line. With modest targeted investment, we can turn stock gap into a backbone. Thank you for your time and your continued work on this.

[Representative Alyssa Black (Chair)]: Thank you, Dan.

[Representative Daisy Berbeco (Ranking Member)]: Now we're gonna hear from Nicole Daisy and Jacob Berbeco will be after that.

[Jacob Berkowitz]: Hello. Thank you. I'm act I'm Jacob I'm actually gonna go first here, and then Nicole will will go after me. So my name is Jacob Berkowitz. I am the president of my union, Staff United at UVM Medical Center. I'm here with my colleague, Nicole DaVita, who is the president of AFT Vermont and the president of her union, the Vermont Federation of Nurses and Health Professionals. And we are joining you from our joint bargaining session with the UVM Medical Center. You might not be able to see behind us, but there's a 100 or so person bargaining team is here as well. But this year, the reason that we're here together is our union has decided to bargain our contracts together as over 3,000 employees because we know we're stronger together. And the challenges we're up against in healthcare are bigger than ever. It's not just universal primary care, but universal healthcare is really the only path forward if we're going to stabilize the healthcare crisis we're experiencing in Vermont and around the country right now. Our employer UVM Health, along with the now defunct One Care Vermont has played an enormous role in structuring the healthcare system in Vermont. And it's no surprise that in a for profit system, they have prioritized costly procedures over preventative care and driven revenues into administrative waste, executive salaries, and popping up less viable facilities in New York state. Vermont is now the most expensive place to receive healthcare in the world, but that money doesn't make it to us as healthcare workers or even to necessarily translate to more quality patient care. Instead we're trapped in a downward cycle. And as the shareholders and executives in pharmaceutical companies, private equity, health insurers, as all of them get richer, we as healthcare workers are constantly being asked to do more with less. That's seeing more patients, cleaning more rooms, covering more shifts across the healthcare spectrum. We are asked to do more with less. Meanwhile, our own healthcare coverage is being cut. And this year, UVM Health actually unilaterally switched our healthcare coverage from Blue Cross to Cigna and our members took the hit. Just this week, we've heard stories of folks who are unable to receive mental healthcare services for themselves due to the changes of insurance. Something has to be done. Thank you.

[Representative Alyssa Black (Chair)]: Thank you, Jacob. Go ahead, Nicole. Thank you. Wait, hold on one second. Next step after Nicole will be Walter Carpenter.

[Nicole DeVita]: Thank you. We know healthcare access in Vermont is a crisis. It's not a debate or a surprise. The question is what we're willing to do about it. As leaders within some of the largest unions in the state, we know the bargaining table is the one tool we have to put pressure on UVM Health. Through our contract negotiations, we're putting together a set of proposals that would benefit not just us as employees, but our whole state. One of those proposals is inviting UVM Health to be a real leader in health care by working with our union to enact the vision of Act 48, Vermont's publicly funded universal health care law. As we see it, UVM Health has played a role in creating the affordability crisis in Vermont. Now it's time for them to be part of the solution. A universally funded public healthcare system would benefit us, our patients, and our whole community. We know there will be opposition. We know hospital leadership says, will say it's politically impossible that our state doesn't have the money or that UVM Health can't take a position on universal healthcare or whatever else they think will demoralize and divide us. Because this isn't yet a crisis for the executives and senior administrators of our for profit system. But we're fighting for a better system because the status quo is a crisis for us as healthcare workers when the hospital budget is being balanced on our backs. It's a crisis for our patients who aren't receiving the care they deserve. It's a crisis for our teachers and schools whose budgets are skyrocketing due to health care costs. It's a crisis for the uninsured who are too afraid of medical debt to receive the care they need. The 2026 Vermonter poll found that 73% of Vermont residents support a universal publicly funded healthcare system. Only 10% were opposed. Amongst our members, 98% believe healthcare is a human right. Universal healthcare is what Vermonters want. We, as unions, are doing our part at the bargaining table to move our state towards a more just and equitable system. Now it's your turn. We need visionary leaders who are willing to take risks and fight for us at the state level. We need you all to champion, not just for universal primary care, but a publicly funded universal healthcare system for all. Thank you for your time.

[Representative Daisy Berbeco (Ranking Member)]: Thank you, Nicole. Walter Carpenter and Peter Ireland will be next.

[Dr. Lance Broy]: My

[Walter Carpenter]: name is Walter Carpenter. I'm 70 years old and I live in Montpelier, Vermont. I'm a single payer healthcare activist with Vermont Healthcare for All and I've served on the Green Mountain Care Board Advisory Committee since 2011. Before I very briefly explain why I strongly support universal primary care, I want to ask a simple question. How much of these is your life worth to you? How much in dollars and cents would you pay to save your life if you have only two choices, pay that or die? This is not a theoretical question. I had to make this choice. Twenty years ago, I didn't fall through the cracks of our health care system. I was a push setter. I had no insurance. My current employer didn't offer it to anyone under the management level. I had lost my previous job after a near fatal bout with liver disease from natural causes. I lost the health coverage that came with it. I also lost access to primary care. The one person who could have caught things early, guided me, helped me avoid what come next. The disease came back and I was on my own. Without that support my condition worsened. I went from normal Caucasian skin color to visibly ill, my skin turning yellow while delays and costs piled up. Eventually I was left with a stark choice, pay for an uninsured operation or die. Which one? A bill like H433 could have prevented this. Access to primary care could have caught my condition earlier and possibly spared me that ridiculous decision. I know that this committee has been wrestling insanely hard on this issue. I've been following it through livestream a lot. I'm asking you to remember, no Vermonter should ever have to put a dollar value on their lives.

[Dr. Peter Ireland]: Thank you very much.

[Representative Alyssa Black (Chair)]: Thank you, Walter.

[Representative Daisy Berbeco (Ranking Member)]: Peter Ireland and Tom Darenthol is on deck.

[Dr. Peter Ireland]: Good evening. My name is Peter Ireland and I've been a full time primary care physician here in Vermont working at CDMC Waterbury Family Medicine for six years. I have a panel of about 1,200 patients, and I work with eight other providers. In total, we take care of about 8,000 people. I'm also a member of the Vermont Board of Medical Practice, though I'm not speaking on behalf of them today. In brief, the points I'd like to make are that we are trying our best to see as many patients as possible without shortchanging the ones we have. Primary care is a difficult job and more and more is being asked of our clinics. And the barriers to getting patients in are providers leaving, or being burned out, retiring, leaving The States, and as you've heard earlier, clinics being closed. With regard to more and more being asked, I'd point out that primary care is the backbone of the healthcare system, and a lot of the important work we do is not reimbursed. Treat your concerns, prior authorization, peer to peer appeals, responding to my chart messages. We have eroded specialty supports with decrease in access to psychiatry, both inpatient and outpatient. Multivascular specialists putting up barriers to referrals, decreased social workers, and lack of staffing on our addiction programs. Because of the difficulties of the work, as chair Black can attest, most PCPs work part time and have side work like express care, teaching, When pressure is to put on to work even harder, most people would cut back on the primary care side, switch to their side venture or leave medicine. Clinic closures have affected access and primary care clinics have been closed because they are not profitable, so we are told. Heard about the Mad River Valley Medical Center in Wakefield being closed, but also up north of us, Memorial Health Partners, Philistope Family Practice. Waterbury Family Medicine is the only clinic in a 15 mile radius around us. I'd argue that primary care work is going to be unprofitable, and the solutions that other clinics, other areas use are not gonna be popular. Decreasing visits to ten to fifteen minutes, doing less at the visits, Medicare wellness visits without actually being seen, aggressive billing, not seeing insurances that don't reimburse well. I'd say a lot of the important work we do is loss leading, addiction programs, death with dignity, home visits to local psychiatric homes. I'd recommend exploring ways to allow primary care to be subsidized, like through the universal primary care efforts, and set up disincentives from health systems closing clinics further. Thank you.

[Representative Alyssa Black (Chair)]: Thank you. Tom

[Representative Daisy Berbeco (Ranking Member)]: Darenthold and Tim Fey will be after.

[Tom Derenthal]: Hi, thanks for having this opportunity. I'm here to sort of compliment what a number of doctors, especially the gentleman who just spoke said. And getting a care from a provider that knows me has been a challenge. Due to optic nerve size differences, any regular ophthalmology visits. But in the last three years, two of the ophthalmologists that I've seen have left, right? And I think they've both gone to either North or South Carolina. And now I actually, I'm waiting for a new ophthalmologist who's supposed to come to the state this fall so that I can continue to get services. In addition, from a primary care point of view, well, I guess I consider ophthalmology primary care. Although I don't know technically what the definition of primary care

[Matt Giles]: is. But

[Tom Derenthal]: my primary provider has also changed twice in the last four years. And I think it's real important to have some continuity. I mean, take good notes and there's a record of the things that are ailing me, but it really makes a difference if you have a care provider for a long period of time. The first person left, they just took another job with the same organization, so they didn't leave. But the second person, their change was precipitated by just the stress of a high patient load. And my current provider

[Governor Howard Dean]: is under

[Tom Derenthal]: the gun to see me quickly so they can get to the next patient. It's really obvious that not that they don't care. It's just that they just need to get it done so that they can move on. And I have a number of chronic conditions that I need to see providers for regularly, and I won't go into that. But I think having university primary care will make attracting physicians and retaining physicians easier for the state. And that will result in better care for the people that see them. And I'm not saying anything about the cost of care, but I am very sympathetic to those people who can't afford primary care because the cost is just too high, which is another good reason. Anyhow, thank you very much.

[Representative Alyssa Black (Chair)]: Thank you.

[Representative Daisy Berbeco (Ranking Member)]: Next we're going to hear from Ken Fei and then Chana Arauchi Mejia.

[Representative Alyssa Black (Chair)]: I'm sorry. Excuse me? You're ramping up really quite badly. Is it possible that maybe you can turn off your video and we can just hear you? That might help.

[Ken Fei]: Sure. But still, I mean, I'm very nervous. I don't wanna take other people's time. I'm just really for this, and I'm probably I wouldn't like to speak for other people who are nervous for for this, but, good, you know, keep it up. Thank

[Representative Alyssa Black (Chair)]: you so much, Ken.

[Tom Derenthal]: Send them an email and ask them to send something in writing. That

[Representative Daisy Berbeco (Ranking Member)]: is Anna, and then Debra Kutsko will be after this.

[Anna (business owner from Norwich)]: Hello. I'm Anna, Anna Dachie Mihiet. I live in Norwich, Vermont, And I'm a mother, a spouse, and a business owner. Our family's lived in Vermont for over ten years, and I've been a business owner in Vermont for over seven years. Let's imagine for a moment someone having a salary of $55,000 That's about double minimum wage, and that would cover housing, groceries, utilities, basic living needs, things that the kids need. Instead imagine that that $55,000 is going only to pay for your health insurance, not even the health care bills, not even the deductible, simply access. With losing the tax care credits, this is what happened to us this year, our family pays over $4,000 a month simply to have health insurance. That's it, before the deductible. So instead of my being able to hire one or two people for my business, we're paying way too much for health care. Today, I was at the hospital. My primary care doc had me do a routine screening, and there was an administrative staff who, and the hospital asked me to pay $300 upfront before the test. Turns out it was a mistake and I shouldn't have been charged at all. And now seven hours later, I'm still waiting for the form to sign to them to submit to request. So now I've lost over a day of work for administrative issues that shouldn't have happened in the first place. Administrative costs, all the things, all the things we've heard today, the inhumanity has got to stop. Health care is the only business exchange where you show up and you don't actually the business can't tell you how much it's gonna cost. And they'll say, oh, maybe you'll find out in over a month. This doesn't exist in any other kind of business exchange. And then there's open enrollment period where you have to make a decision very quickly, and then you are stuck for twelve months under rare instances you can change. The inhumanity has got to stop. We have heard how Vermont has the highest health care insurance in the nation, and for the first time in over a decade, our family is having to seriously think about relocating back to New Hampshire. People who love Vermont cannot stay. Thank you for listening to us. You are in a position to keep Vermonters in Vermont, to build a place where Vermonters can thrive. Please help us. We need universal health care. Thank you. Thank you, Anna.

[Representative Alyssa Black (Chair)]: Thank you. Debra Kunso and Jean Hopkins is on deck.

[Debra Kutsko]: Thank you for allowing me to speak tonight. Really what I'm saying you've heard over and over again. I'm a nurse practitioner. I began my professional life over fifty years ago at what was then the People's Street Clinic, which turned into the community health center. After decades of nurse practitioner at the UPMMC and in my retirement, I now volunteer at the Open Door Clinic in Middlebury, another place where people get care who would not otherwise be able to get care. With this long and involved view of Vermont healthcare landscape, I have to ask, why are we still talking about this? What are we doing with the same problem? It's abundantly clear that pharmacists young and old still can't afford the care they need. When people delay care, you've heard this, the cost of difficulty in accessing care, their conditions worsen, leading to more serious illnesses, higher medical expenses, missed work, and lost wages. That is in addition to the strain it puts on our healthcare system and providers. I've witnessed this over and over again throughout my career and it will continue until we do something. Vermont can and must do something better for all. It's a residence and I thank you for the work that you're doing. Thank you so much. Thank you.

[Representative Daisy Berbeco (Ranking Member)]: Jean Hopkins and Gabrielle Lueders will be present.

[Jean Hopkins]: Okay. I'm Jean in Burlington. I've been a member of the League of Women Voters for thirty years because they support a healthy democracy with not only voting rights, but also the need for universal health care. As an elder, I am fortunate to have Medicare to help me pay for doctor appointments. My daughter and husband who were fortunate to live in Norway for four years where they didn't have to buy health insurance and were assigned a doctor as soon as they moved there, considered not buying health insurance when they returned to The US, but she needs health care. I want her to be able to live as long as I have. H433 and S197 for universal primary care in Vermont will give everyone access to a primary care doctor which will help to keep us all, no matter what our income is, healthier with preventive medicine which will cost us all a lot less. Thank you.

[Representative Daisy Berbeco (Ranking Member)]: Thank you, Debra. Debra and Susan Scofield will be next.

[Debra (candidate for Washington District Senate)]: Thank you to members of the committee for this important hearing. Just incredible stories that we're hearing tonight and I'm here from Montpelier. I'm here as an interested citizen concerned about affordability and also as a candidate for the Washington District for the Senate this time fall. There's a basic principle in insurance called the law of large numbers. The larger the group, the more predictable the risk, the lower the cost for everyone. When Vermonters are divided into many small pools, premiums rise, administrative costs rise, and more people fall through the cracks. Universal primary care applies this principle in the most practical way possible creating one broad stable pool for the care Vermonters use most. Primary care is where best outcomes come from. It's where prevention happens, where chronic conditions are managed, and where problems are caught early before they become dangerous and expensive. The research presented by Vermont Healthcare for All shows that primary care is also the least costly part of the system averaging about $44 per person per month and that universal access consistently improves population health and lowers total system costs. For me this is personal. My father died from non Hodgkin's lymphoma after delaying care for so long the disease was too advanced when he was finally seen. This delay was driven by cost concerns. My mother-in-law died from complications related to diabetes. Complications were also tied to cost barriers and would have been avoidable with consistent primary care. These stories are not unique. They reflect what happens when people wait because they're afraid of the bill. Lives are lost because of lack of access. Health outcomes are poor and the system becomes more expensive when we focus on major disease instead of prevention. Universal primary care would guarantee access to basic care for every Vermonter, reduce under insurance and allow conditions to be treated earlier when they are far less costly. It would also reduce administrative burden on providers and help stabilize the workforce. Eight Vermont towns have already voted to move towards universal publicly financed primary care. Vermonters are asking for action. Universal primary care is the most achievable, affordable first step towards a healthier, more stable system for everyone. I encourage you all to think not just about this session, but we need to take action. Affordability is a crisis. Thank you so much.

[Representative Daisy Berbeco (Ranking Member)]: Thank you. Susan Schoenfeld, sorry. And Patrick Flood will be next.

[Representative Karen Lueders]: Hi, thanks for this hearing and the opportunity to speak. My name is Susan Schoenfeld. I'm retired from working for twenty five years in the Vermont Department of Health Infectious disease program as the deputy state epidemiologist. I will focus my comments on the importance of access to primary care and stopping the spread of infectious diseases. Epidemiologists study the distribution of diseases within communities, what causes these diseases, and how to prevent and control them. Doing this important job requires working closely with the medical community, particularly with primary care providers. PCPs notify public health when their patients have diseases that present risk to the community so that public health measures can be taken. The health department then relies on PCPs to take care of the medical needs of these patients. The types of infectious diseases investigated by the health department range from respiratory and sexually transmitted infections through tick borne, diarrhea, and vaccine preventable diseases. Individuals with these conditions need access to primary care for treatment. Communities want to see these diseases controlled to minimize the risk to others. The health department won't know about these infections so can't control them unless primary care physicians identify and report them. A timely example is measles. The health department notifies providers of a wastewater surveillance sample in Vermont that tests positive for measles. Primary care providers then have a heightened suspicion for identifying a case early and can promptly report it. The health department can then warn the public at risk, recommend various measures to limit transmission, and encourage people to to contact their PCP to get a measles vaccine if needed or call their provider if they have symptoms that could be measles. PCPs can then identify other cases early and make sure they get appropriate care and work with the Vermont Health Department for disease control recommendations. Vermont's health department depends on primary care providers. This important partnership with public health and primary care can work beautifully but it falls apart when individuals don't have access to primary care. If people don't have a primary care provider they are less likely to have received standard preventive care measures and less likely to get care early in the course of their infections. For infectious diseases early care access is important not just for the sake of the individual but because early detection can help minimize or stop the spread of disease to others. People's Health requires a strong public health system and a well functioning health care system with access to primary care. We know that healthcare is too often a heavy or impossible financial burden. The lack of primary care access for any portion of our population is not only a health risk for those individuals, but presents an increased risk for all of us. It's important, it's more than time to face up to this and boldly move forward, starting with universal access to primary care. Thank you.

[Representative Alyssa Black (Chair)]: Doctor. Flood,

[Representative Daisy Berbeco (Ranking Member)]: Liz Eddahl is up. Good

[Patrick Flood]: evening. Thank you all for having this hearing. Thanks for a long day to you folks, and I appreciate your time. Two and a half minutes is not a lot of time to talk about the health care mess we're in. Do not wanna repeat what what about what you've already heard. I would rather talk about where do we go from here. I certainly support the bill that you're considering. I would offer that it's not enough. It's not soon enough, and every story you've heard tonight illustrates that. Where where can we start? How can we start? We have the system. We have doctors. We have FQHCs. We have private practices. We have the system. We but they don't have enough money to do what needs to be done, to be paid properly, to have enough doctors to see people in a timely fashion. It there's a system, as somebody said a few minutes ago, that is collapsing. If we wait, it will collapse. Doctors are leaving already. So what I'd like to talk about first briefly is how do we get here? And it's gotta be brief, obviously. But we our hospital system is terribly mismanaged, way over cost, and it's driven mostly by the by the UVM Medical Center. Now I know some of you are from Chittenden County. I'm sorry if I'm gonna insult you. But the main reason we're here tonight having this conversation is because the UBM Medical Center and Health Network for a period of ten years gouged Vermonters and almost sent Blue Cross Blue Shield into bankruptcy. We have to change that, and I know you are working on certain parts of the system that will help with that. I'm here to say it's time to claw back some of that money that they took from us over that decade, And there's a way to do it, and I'm not going to get through the whole thing here, but I'd be happy to talk to you about it more. I think we should reduce the rates in Medicaid that we paid to the UVM Medical Center, so that we can save $20.30, $4,050,000,000 dollars a year, whatever you choose to make sense. We can invest that money in July. Well, that might be an exaggeration, but we can invest that money very soon in in building up primary care and the the other parts of the system that are suffering that you've heard from about tonight. The other thing we can do is what governor Keith said and just tax Richmond monitors more. Although I understand there's not much, taste for that in the legislation this year. If you wanna talk to me about any other aspects of the system change, I will spend as much time as you want telling you my ideas. I spent thirty years in state government. I ran federally qualified health center. I know a little bit about health care. Thank you very much.

[Dr. Peter Ireland]: Thank you. Good morning, Liz.

[Representative Alyssa Black (Chair)]: And the final person on my list will be Glynnae Sewell.

[Liz Edsel]: Hi, I'm Liz Edsel. I'm the Associate Director of VPERG, the Vermont Public Interest Research Group. And I'm from Windham. Hi, Daisy. So VPERG is a long standing supporter of universal health care. Until that goal is achieved, we strive to offer our staff high quality health coverage and managing that benefit is part of my job. And it impacts me personally because my family is on

[Dr. Ke Tian]: our health care

[Liz Edsel]: plan. Over the last three years, our premiums have skyrocketed. Blue Cross Blue Shield kicked us off of our low utilization plan. And then the Green Mountain Care Board the next year increased premiums by double digits. So the same plan for the same group of employees cost us 46% more in 2024 than in 2022. 46% more. There's a reason why I'm going gray. So in 2025, we had to switch. We could not continue to afford that. We switched to a high deductible bronze plan with a health reimbursement account that covered some, but not all, out of pocket costs. We could buy up to a higher level plan to minimize the out of pocket costs. I chose to try the cheaper plan and see how that went. It did not go well. So as my family neared our HRA cap, we started delaying our care. Fewer mental health visits and a lot of wait and see. And then our child was injured, my back flared up, my husband hurt his knee. We ended up spending thousands of dollars out of pocket and were less healthy because we waited. And we are not alone. A national study found that patients on high deductible plans have fewer primary care visits, even cost exempt preventative care. And those least likely to seek care are people with low incomes and poor health. So this marketplace is not working as intended. It's a market failing the people it's supposed to serve and leaving employers like me to manage complex insurance decisions that we are not well equipped to make. Publicly funded, universally accessible primary care would take this burden off of employers and families and we would all save money because we're getting the care we need early before small problems become costly ones. I urge you to move Vermont toward universal primary care. Thank you very much. Thank you Liz.

[Representative Daisy Berbeco (Ranking Member)]: All

[Debra (candidate for Washington District Senate)]: right, everyone. I appreciate being the last one

[Glynnae Sewell]: to speak. I don't have much to say. But I've been in Montpelier for fifteen years is when I moved here, almost fifteen years ago. But I went through a double infection health crisis right about this exact time frame, February and March, fifteen years ago. As a result of my treatment from a local facility near here in Montpelier, they accidentally ended up giving me a secondary infection, but didn't realize it until I came back to them. And they went, oops, the way we treated you, we should have given you something else added to that to prevent the second infection. And as a result, that caused a lot of issues in my body for about a decade after that. And then I'm still coming down over it. It left blotches all over me, did a lot of damage. But my thought is this, the universal system did not mean an automatic lowering of quality of care. So my thought is, we need to make sure we have a system of positive comprehensive quality of care protocols. Something to include the administrative level of quality of care protocols that need to be followed to prevent a lowering. Some people will say, oh, a universal system means you won't get as good

[Tom Derenthal]: a quality if you have

[Glynnae Sewell]: a private. That cannot mean it cannot go in that direction. There needs to be a high quality of care protocol set in place to include the administrative affairs that lead for minor billing issues or no billing at all. People should not get caught up and accidentally being made sicker and then being asked to pay fees that they shouldn't have ever been asked to pay for. So it's really important that also I remember thinking, I've had my teeth worked on. And the thing is, had I waited any longer, turns out I had an infection there as well. Had that led to my brain, that would have been an instant whirlpool breach. So that would have been gone. So when we say, oh, we don't include dental, we don't include eye, how not? I'm nearly blind anyway. And how do we not include dental in primary? That has come up. Eye care has come up. So and I'm glad to pay an increased level of tax in order to cover the entire system. All of us have always said that the people I hang with have said that and I wanted to make that point here. I appreciate you all listening to me.

[Representative Alyssa Black (Chair)]: Thank you. Thank you.

[Unidentified Committee Staff/Facilitator]: I think that's everyone we had.

[Representative Alyssa Black (Chair)]: We really want to thank everyone for coming out. And I have Paige highlighted notes, and we really appreciate hearing from you and sharing your perspective with us. And stay tuned and watch to see where we go.

[Representative Karen Lueders]: Thank you.