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Appropriations committee advances primary care payment‑reform bill requiring insurer reporting and studies toward universal primary care
Summary
The committee advanced S.197 / S.1 97, a bill directing studies and payment‑methodology work toward potential universal primary care. It requires insurers to report payment data, asks the Blueprint program to recommend per‑person spending targets, and sets reporting deadlines (primarily Jan. 15, 2027).
The House Appropriations Committee voted to advance S.197 / S.1 97, which directs a series of reports and analyses aimed at evaluating payment reforms to support primary care and to explore whether a blueprint mechanism or other approaches could support universal primary care in Vermont.
Jen Garvey of the Office of Legislative Council summarized the bill for the committee: it updates Blueprint statutes, requires health insurers to submit quarterly (or more frequent) information to the Agency of Human Services for comprehensive fiscal analysis, and directs the Blueprint director to prepare a report by Jan. 15, 2027, that would define routine primary care services, analyze payment methodologies and risk adjustment, and propose an operational plan and timeline for implementation. Garvey said the bill also directs insurers to make per‑person‑per‑month payments to practices “in amounts at least equal to Medicaid payments beginning in 2027.”
Committee members asked about potential effects on private insurance premiums and hospital use. Courtney Norris of Blue Cross Blue Shield of Vermont told the committee that bringing PMPM payments to Medicaid levels would increase her organization’s costs by roughly $3.4 million and could lead to a small increase in premiums; she added her insurer runs its own value‑based initiatives that offset some costs.
Members debated whether the bill contains too many studies or whether the Blueprint has been adequately evaluated in the past; speakers urged that agency responsibilities (Agency of Human Services, Green Mountain Care Board, Department of Financial Regulation) be clearly aligned to avoid siloed work. The bill also requires the State Treasurer’s office to explore a possible regional universal primary care program with neighboring states and contains a provision requiring at least 60 days’ notice to plan enrollees before removal of a prescription from a formulary.
The committee moved and recorded a roll‑call vote to advance the bill as recommended by the House Health Care Committee. Next steps include scheduling for floor consideration and any required follow‑up reports or clarifications.
