Senate Health & Welfare hears testimony on S.197 and models to boost primary care funding

The Senate Health & Welfare Committee on an S.197 hearing heard multidisciplinary testimony on a bill designed to increase Vermont's primary care investment, shore up struggling rural practices and transition payments away from fee-for-service models.

Dr. Anne Morris, a family physician who said she is the "associate dean for primary care, NHAC Abilara College of Medicine," opened with patients'cost challenges and workforce concerns, saying "for every $1 spent in primary care, it saves the system $13" and noting that "As of December 2025, there were 79 open primary care positions in the state." Morris urged earlier implementation of the bill's proposed 15% primary care spend rather than a delayed timetable.

Sarah Rosenblum, interim director of health care reform at the Agency of Human Services, and the agency's executive director for health care reform described work underway through the Blueprint for Health and the federal Rural Health Transformation (RHT) application. They said the state has proposed three core RHT commitments: modernize the payment model, reassess advanced primary care access standards, and consolidate multiple Blueprint payments into a single, comprehensive payment. Agency staff warned the committee of a compressed federal timeline: a report to CMS is due by August, FY26 funds must be obligated by October, and the money must be spent by 09/30/2027 to secure later years of funding.

Committee members pressed the agency on sustainability and whether RHT grant dollars can substitute for recurring state funding. Agency staff said fiscal analysis depends on final federal negotiations and that the state could adjust its budget if required; they also emphasized that RHT grants generally cannot be used to pay salaries but can support per-member-per-month payments and workforce-related investments.

Tom Boris, CEO and CFO of OneCare Vermont, described operational lessons from OneCare's Comprehensive Payment Reform program. Boris said administrative capacity, active monitoring and upstream arrangements with payers are essential to run fixed monthly payments and link those payments to total cost of care. He emphasized the practical needs of provider supports, data collection and contingency cash flow to smooth payment timing and reconciliation.

Dr. Wayne Altman, chair of family medicine at Tufts Medical School and a lead on Massachusetts's primary care legislation, described Massachusetts'approaches including a "primary care stabilization fund" that would extract primary care from insurance and pay practices directly, funded initially by temporary assessments on commercial payers, large hospital systems and other stakeholders. Altman said the Massachusetts model aims to ramp primary care investment toward about 15% of total health spending and argued a dedicated fund can reach employer self-funded populations that state regulation cannot compel under ERISA.

Legislative counsel Jen Garvey asked how removing primary care from insurance would comply with federal ACA and ERISA rules. Altman said his team has legal memos addressing those concerns and offered to share them with committee staff.

The committee asked witnesses to submit written testimony and additional details on fiscal analyses, operational plans for equitable access, and how federal RHT and state budget actions would be coordinated. The chair closed by thanking witnesses and saying follow-up and additional hearings are likely.