House Health Care committee advances study-focused rewrite of S.197 to evaluate pathways to universal primary care

The House Health Care Committee met May 13 to review draft 1.3 of S.197, a bill that asks state agencies to study how Vermont might move toward universal primary care rather than immediately changing payment law. Chair opened the session by saying the draft is intended to obtain information necessary to develop an implementation framework while recognizing time constraints before crossover.

Legislative counsel Jen Carbby walked the committee through changes from the Senate version. The draft keeps a stated legislative intent to invest in primary care and to study “universal primary care” while moving statutory spending mandates into investigative reports. Carbby told the committee that the draft asks the Blueprint for Health and other agencies to define which services count as routine primary care, recommend attribution and risk‑adjustment methods, and propose transitional per‑person, per‑month schedules that could be adjusted by payer characteristics.

Committee members pressed for clarity on whether the bill privileges the existing Blueprint for Health as the assumed mechanism for implementation. Several members urged adding language to make clear the study should evaluate other approaches as well, not only optimization of the Blueprint. The chair said the intent is to have the Blueprint examined ‘‘to determine whether it is an appropriate mechanism’’ and that the bill could be adjusted to explicitly allow consideration of alternatives.

Section 5 drew extended debate. The draft directs the Agency of Human Services (AHS), the Green Mountain Care Board and the Department of Financial Regulation—working with the Office of the Healthcare Advocate—to evaluate how healthcare regulation and reform functions should be distributed. Members repeatedly raised concerns that such a process could spotlight existing overlaps or ‘‘turf’’ conflicts and asked that reports explicitly document areas of agreement and disagreement so the Legislature can resolve them.

AHS staff described the agency central office structure and where Medicaid policy, the Blueprint and the Office of Healthcare Reform sit inside that organization. Committee members noted testimony earlier in the record that the Blueprint is already engaged in efforts to modernize measures and administrative tasks; the committee expects those ongoing activities to inform the reports called for by S.197.

Multiple reporting deadlines were discussed. Several report elements (definitions, payment‑methodology recommendations and baseline estimates) were set with January 15 deadlines in the draft; the section asking for a review of universal primary care efforts in other states is slated for a January 15, 2027 report. The draft also would require the Blueprint director (or designate) to be available July–December 2026 to brief the Health Reform Oversight Committee on progress.

On resourcing, members observed that producing actionable implementation plans or detailed fiscal modeling typically requires additional staff time or consultant contracts and that the draft contains no appropriation. Committee discussion referenced a prior, comprehensive study done with academic support that participants said cost in the mid‑hundreds of thousands of dollars; a legislative staffer reminded the body that final cost depends on the study scope and method.

The committee did not take a formal vote on S.197 on May 13. Members asked that additional witnesses from the named agencies be invited to speak to Section 5, and the chair scheduled continued consideration of the measure in upcoming meetings. The next convening was identified for June 11, with committee members expecting to refine statutory language and to consider public testimony and agency feedback before any final action.