Lawmakers review bill to boost primary care access, set 15% spending target

Representative Herb Olsen walked a legislative committee through H 680, a bill to establish a voluntary primary care access reform program that would pool payer contributions, provide capitated per-member-per-month payments to participating primary care practices and set an initial statewide primary care spending target of 15 percent to be met by Jan. 1, 2029. Olsen framed the proposal as a way to increase access while reallocating existing healthcare dollars rather than raising total system spending.

The bill, as explained by Jen KBY of the Office of Legislative Council, directs the Agency of Human Services in coordination with the Green Mountain Care Board and other entities to operate a payment pool funded by a portion of commercial premiums, premium equivalents from participating payers and, as permitted under federal law, public program dollars. KBY said a 2020 Green Mountain Care Board and Department of Vermont Health Access report estimated that 10.2% of all healthcare spending was allocated to primary care, with variation across payer types.

H 680 would: create a voluntary primary care access reform program; require the agency to adopt rules for a risk-adjusted allocation model; limit program quality measures to 12 and require a primary care practice adopt no more than six; reduce administrative and documentation burdens by aligning payer requirements; and distribute capitated payments that cover routine primary care without patient cost sharing for attributed patients under participating plans. The bill also directs outreach to Medicare and self-funded employer plans to encourage voluntary participation.

Representative Herb Olsen argued the changes would both improve access and lower costs, saying, "a dollar spent on primary care will eventually save about $13 in system costs." Committee members raised concerns about potential revenue impacts for hospitals; Olsen acknowledged hospital pressures and said the intent is to reallocate existing spending rather than simply cut hospital revenue.

The bill includes workforce investments. KBY said H 680 would appropriate $6.75 million in fiscal 2027 for primary care workforce initiatives, including $1.25 million for a Maple Mountain family medicine residency and $5 million for the Vermont Educational Loan Repayment Program to support clinicians practicing in primary care. KBY also described reporting and implementation timelines: the agency is directed to begin program operation by July 1, 2027, provide an initial implementation report by Dec. 15, 2026, and deliver an operational and financial plan for program expansion not later than Jan. 1, 2028.

Supporters told the committee the proposal aims to reduce the administrative load on primary care clinicians—who report spending large portions of time on billing and documentation—and to align payers to simplify practice participation. The bill asks the agency to limit indirect primary care spending and to establish benchmarks and a transitional schedule to reach the 15% target without increasing overall health care spending.

The committee plans to review related Senate language (S197) in an upcoming session; KBY noted some sections mirror S197. The walkthrough concluded with members planning to consider the bill text and stakeholder feedback as the legislature moves forward.