Physicians, residents urge phased expansion of Green Mountain Care in support of H.433

A legislative committee on April 1 heard testimony from physicians, residents and the Office of Legislative Counsel in favor of H.433, a bill that would begin an incremental implementation of Green Mountain Care by immediately covering comprehensive primary care with no cost‑sharing and then phasing in additional services over a decade.

Dr. Alan Ramsey, a family physician with 44 years’ experience and a former Green Mountain Care Board member, told the committee H.433 is “a natural progression to Act 48” and urged the state to invest more in primary care, mental health and community‑based services to improve quality and control long‑term costs. “Primary care is 6 to 8% of the spend in Vermont… That will never improve the quality of care we provide,” he said, adding that per‑person health expenditures rose from about $7,000 in 2018 to roughly $11,500 in 2024.

The bill’s text, explained by Jen KBY of the Office of Legislative Counsel, would make Green Mountain Care’s first year benefits all primary‑care services — including outpatient mental‑health care and substance‑use treatment — and prohibit co‑payments, coinsurance and deductibles for those services. Year two would add preventive dental, vision and certain hearing services. Years 3–10 would expand priorities such as prenatal and neonatal care, diagnostics and outpatient specialty services as the universal‑health advisory group makes recommendations to the General Assembly.

KBY told members the bill retains a federal trigger: the secretary of human services would be directed to seek a section 1332 waiver under the Affordable Care Act to allow some federal pass‑through funding and to modify qualified‑health‑plan benefit designs. The bill also contemplates seeking Medicaid/CHIP or Medicare waivers if the state wishes to wrap federal beneficiaries into the program.

Supporters said an incremental approach could demonstrate savings and make primary care a more attractive career. Reese Naidker, a UVM family‑medicine resident and representative of the Committee of Interns and Residents, described a recent intensive care case he linked to lack of primary‑care access and urged that residency and recruitment investments be part of any move to expand coverage.

Several witnesses and members discussed financing options. Dr. Ramsey and other speakers suggested approaches including a dedicated primary‑care trust fund, payroll or self‑employment levies, or phased reallocation of commercial and public spending into a single Green Mountain Care fund. KBY emphasized the bill as drafted sets legislative intent rather than a single financing recipe and charges an advisory group and the Green Mountain Care Board with sequencing and fiscal analysis.

Committee members pressed witnesses on workforce incentives, the role of capitation or per‑member‑per‑month payments and how hospitals and specialty care would be affected. No vote was taken; staff said the committee will receive the reports and operational plans the bill directs (including a benefit‑sequencing advisory group and fiscal analyses) and continue hearings.

The bill as drafted does not immediately change private plans for non‑primary care benefits; KBY explained individuals could retain supplemental private coverage for services not yet included in Green Mountain Care while the program phases in. She also cautioned that certain changes — notably removing primary care from required benefits for qualified health plans — would require the federal 1332 waiver.

The committee scheduled follow‑up work and stakeholder briefings and will review the advisory‑group recommendations and fiscal reports mandated by the bill before deciding next steps.