Health Policy, Politics, and Perspectives

Joint Legislative Committee Hearing on Health Care Part 1

Claire: [crosstalk 00:00:00]

Thank you everybody for coming tonight. This is a joint hearing of Senate Public Welfare and House Healthcare. We've invited you here to talk to us about issues with access to healthcare. As you know, at least in Senate Health and Welfare we're considering a new bill called Universal Primary Care, looking at ways we can arrange for everyone to have access to primary care, and so we're interested in hearing your experiences to get in the door for healthcare.

Speaker 2: Thank you Claire. Again, welcome to the state house. This is an opportunity for us to listen, and for you to share what you want us to hear. Share your stories. Again as Claire said, each witness will be given up to three minutes. Let me also mention while Claire's committee is taking a bill on Universal Primary Care, our committee is also involved in looking at issues of affordability, hearing from the office of the healthcare advocate, and looking at issues that are impacting Vermonter's access to healthcare.

I attempted to give a little speech but I won't. But just to somehow say that many of us share a common goal, and for many of us it's a question of how to get from here to there. We have adopted staffing act 48, that is state law, which talks about access to universal healthcare for all Vermonters. And we are here tonight to hear from you, to hear how we can move ourselves forward in this journey.

So what I'd like to do now, is to welcome each of our committee members just to introduce themselves by name and the community that they live in and represent. And we use this to go around, I think it'd be good for you to hear.

Ann Cummings: Ann Cummings, I'm a senator from Washington County.

Ann Donahue: Ann Donahue, representative from Northfield [inaudible 00:02:43].

Laurie Hilton: Laurie Hilton, representative [inaudible 00:02:43] Junction.

Brian Cina: Brian Cina, representative from Arlington.

Dick McCormick: Dick McCormick, I represent the Windsor County district.

Sarah Copeland-Hanza: Sarah Copeland-Hanza representative from Bradford.

Ann Marie Christensen: Ann Marie Christensen, representative from Chester. [inaudible 00:03:16] sorry

Ben Vickling: Ben Vickling I'm a representative from the Randolph area.

Tim Briglin: I'm Tim Briglin, I'm a representative representing Norwich, [inaudible 00:03:26] Stratford and Channing.

Representative Gage: Representative Gage from Rutland City.

Jeanine Lyons: Senator Jeanine Lyons representing [inaudible 00:03:38] district.

Debbie Ingram: Senator Debbie Ingram, also from [inaudible 00:03:42] district.

Speaker 2: So, yes, thank you for talking about you today. And after each witness we'll add the other contact folks.

Heather Pembroke: Hi, my name is Heather Pembroke and I live in Huntington, Vermont. I have three points I would like to make today about our healthcare situation. One from the past, one from the present, and one from the future. Looking to the past I am a daughter of an 87 year old cardiologist. When I was growing up, he supported me to pursue any career that I could imagine, yet one caveat he made was to strongly discourage me from going into medicine, his vocation.

He was practicing medicine when a seismic shift occurred in healthcare. Decisions about patient care shifted from medical professionals to insurance companies. He went from being able to spend an hour conducting a physical, to 15 minutes. He no longer got to decide what was medically necessary. Instead, people with no medical degrees had the greatest power over how he treated his patients.

Just as my father believes, I believe that healthcare should be based on medical need, not profit margin, and not made by people who have no medical training. My second point involves the present system, due to a recent disability of my husband. Four years ago, my healthy, thin, athletic, organic food eating, non-smoking, 47 year old husband had a stroke for unknown reasons.

As a state of Vermont employee, I have the same healthcare benefits that you do. A so called Cadillac plan, yet even with this, we had tremendous out of pocket costs for treatment that was medically necessary but not covered by our healthcare plan. My husband now struggles with a communication disorder called aphasia, which is the same communication disorder Gabriela Giffords acquired when she was shot. When the part of the brain responsible for communication is damaged, you lose your ability to speak, read, write, and understand communication.

This devastating condition can improve dramatically with speech therapy, and yet our healthcare system, mine and yours, arbitrarily caps therapy for both speech, occupational, and physical treatments, regardless of the need, regardless of medical/professional's recommendations.

My last point is about a better future. A future that puts patients first. My husband's father was Austrian and used both the Austrian and American healthcare systems. The Austrian healthcare system is superior to the American's, and it costs about half. It's about $4,500 per capita, why the American system is about $8,500 per person, per capita. Excuse me.

So in conclusion I would just like to say that I support universal primary care as a first step, and I believe it is the first step towards a future where we'd have better healthcare, and thank you for your time.

Jill Charbonneau: Jill Charbonneau, I'm from Middlebury Vermont, I'm president of the Vermont AFL-CIO. We have passed resolutions in support of universal primary care. I would like to say to this group of people, we could raise the minimum wage to $25 an hour and still people would find healthcare beyond their touch, even with insurance as we just heard moments ago. I was heartened to hear the testimony from Dr. David Reynolds, that it's possible to utilize the federally qualified healthcare program already in existence in Vermont to spread this program. And I also believe Dr. Alan Ramsey said that we have the experience in [Diva 00:07:38] through Catamount Health to administer this program.

So I hope we can get around ourselves, and get over the barriers, and really move this. I like Dr. Reynold's idea because I think it could move across the United States in that manner. And lastly, I would say that taxpayers have footed the bill for medical industrial complex, and they're the real reason why we don't have adequate healthcare, and I hope this state can take a step forward and move around so that people can get the care they need. Thank you.

Speaker 17: Hi, I'm a 64 year old woman, and I could, hopefully, retire in August. It's not looking that way. I make $10.75 an hour, I pay $55 a week in healthcare. As of three weeks ago, I only made $10 an hour, but I paid $55 a week in healthcare, which to a lot of people it's a lot, it's a lot of money, with a $5,000 deductible. I can't do it, and we're required where I work, to have insurance or we don't have a job. Something has to be done to help people, young people, old people, in-between. No one should go without healthcare in the United States, absolutely no one. Everyone needs help, and I'm hoping before I die, that we can find a common ground so everyone in this country can have healthcare. That's all I have to say, thank you.

Speaker 2: Thank you.

Ethan Parke: My name is Ethan Parke, and despite my age I have a daughter who is in her second year of pre-kindergarten, and I want to thank you Vermont legislature for recognizing early childhood education as a public good, and funding it with taxes. It is one of the best things you have done in recent years, universal publicly funded pre-K. In my opinion your record is not so good in healthcare.

I'm 67 years old, I've worked all my adult life. I'd like to scale back and do all the things that they say you should do to stay healthy. Exercise, sleep, work in the garden, read books, volunteer in the community, eliminate stress. But I cannot retire because although I would go on Medicare, my wife and daughter would not be so lucky. I must keep my job in order to have health insurance that covers them.

I have been in favor of universal publicly funded healthcare for as long as I can remember. I have attended countless public hearings just like this one here in this building. I think the first one I attended was in 1987, and it was around the bill introduced by representative Paul [Porier 00:10:33] and senator Peter Welch, to fund healthcare for the uninsured using a combination of payroll and income taxes.

I hate to say this, but nothing ever changes. We are offered false hope, including now the well intentioned ACO and all payer schemes. These ideas are supposed to control costs and maintain quality. We don't yet know if they will do that. We do know that payment reform by itself will do very little if anything to increase access.

Polls show a majority of Americans favor single payer Medicare for all. 85% of people identifying as Democrats favor it. I think the same could be same for universal primary care. Yet many democratic officeholders tell us that now is not the time, it can't be done, it's too much of a change, it's too complicated. More studies are needed, the Governor will veto it. Federal law is in the way, and so forth. I have heard it all.

Many of you are philosophically onboard, and I thank you. But shallow understanding from people of goodwill is more frustrating than absolute misunderstanding from people of ill will. You know who said that? It was Martin Luther King Jr. Now we are faced with devastating cutbacks from the federal government, cutbacks in Medicare and Medicaid, and ACA subsidies, and CHIP, and funding for FQHCs. What better time than now for the Vermont legislature to devise a system to provide healthcare for all people, despite the cruelty coming out of Washington.

Please do not let this session go by without taking a meaningful step forward on access to healthcare. You have the universal primary care bills before you. Please work on them to strengthen them, and to add the nuts and bolts that will get us to our goals. One idea would be to expand FQHCs to every corner of the state, and to provide them with funding to make primary care universal and free at the point of service. Where there is a will, there must be a way. Thank you.

Sandra Pond: My name is Sandra Pond and I am 64 years old. If I didn't have Medicaid I wouldn't even be able to go to physical therapy, or anything. But I think I would like to have this new legislature to say we're going to give the state of Vermont Medicare with no copayments. Because I went to physical therapy today, it would have cost me over $700 for one visit. And that is not good. And I live in Barre Vermont. And that's all I have to say.

Speaker 20: Access to healthcare begins when you call for an appointment. The person who answers your call is the first point of medical triage in the healthcare delivery system. When that person's well trained and knowledgeable, you get to see the person at the right time for your situation. Unfortunately in my experience, that doesn't happen very often. For example, around Thanksgiving my 31 year old daughter received a death sentence after more than a year of being bounced around from one length appointment to another, with repeated trips to the ER in three different hospitals.

Schedulers without any medical training, perhaps with nothing more than a high school diploma, decided who would evaluate my daughter, and when. It took more than a year, and the third or was it the fourth trip to arrive at the diagnosis of rare stage four cancer. Schedulers who are currently centralized UVMC rather than functioning from departments in the past, where a nurse or doctor could triage without consulting medical history, chose the doctor, not the choice of the primary care physician.

Other schedulers decided when my daughter got subsequent referrals, because there was no staff request from the primary care doctor. If you were in my shoes and trying to access healthcare for your children, what would you do? Would you want to risk your children's health by delayed or inappropriate deferral? Are there steps we can take together to protect and advocate for those we love which will improve the appointments and triage process?

These are the questions I've been thinking about, and possible legislative approaches. Can you recommend a strategic review and implementation of best practices of appointment triage centered on the patient, not on the economic efficiency of the medical system? What can you legislators do to further the reeducation of doctors and patient doctor's strategic communication? Can the Vermont health department take the lead and state-wide public education of patients, and how to communicate with the medical system and how to access care.

The legislature has the ability to regulate appointment centers just as they do other professions. Appointment setters must be trained with standardized triage protocols, which include referring to higher medical triage by other medical specialists when it's appropriate. Their responsibilities and liabilities can be standardized, and there is accountability for license people.

For example, the state already regulates the Vermont office of professional regulation, barbers and cosmetologists, because they're work can impact healthcare. Our medical schedulers don't? Getting an appointment at the right time with the right doctor has a serious and permanent effect on health and medical outcomes. Appointment setters should be accounted for their roles. Would my daughter's prognosis been the same if she had been triaged properly when she first tried to get help? Perhaps not, but she would have been spared months of anxiety, pain, emotional and economic dysfunction.

I urge the legislators to facilitate regulatory fixes and use its power of health oversight to study the prevalence of such tragedies and recommend strategic improvements.

Patricia Reed: Thank you for the opportunity to address this group in support of universal primary care and bills S53 and H248. My name is Patricia Reed, and as a resident of Addison Vermont, I'm a newcomer to this wonderful Vermont community. There are some people here today who welcomed me to the Green Mountain state as coworkers and friends. I'm here to implore you, members of the committee, to welcome you as legislators. I think I am an example of the kind of person you want to attract to this state. I am educated, employed, and involved in this community.

Additionally, I am one of the 63% of Vermonters aged 18 to 24 who are underinsured. Underinsured means essentially, that although I carry private health insurance, I do not have access to care when I need it, due to financial barriers. Those financial barriers are so high for me that I am unable to pay my premiums. Beginning February 1st, I will be uninsured for the rest of this calendar year. If I am sick or injured this year I will treat it at home.

As someone with known health issues, prescribed medications, and friends that have been hospitalized for illness treated ineffectively at home, this risk is particularly terrifying for me, yet it is one that I have to take under our current system. It does not have to be this way. If my friend had access to a PCP, they would have prescribed antibiotics earlier, potentially keeping him out of the hospital, and in his role as a public servant to his community.

My own health issues are minimal, and easily treated with regular visits to my primary care provider. A PCP can prescribe me the medications that keep my thyroid regulated, something 20 million Americans need care to maintain. They can also manage my polycystic ovarian syndrome, something that when gone untreated, will effect my weight, my mood, and even my ability to have biological children.

My anecdotes and ones from others speaking here tonight are indicative of a systemic problem, a problem that we can begin to rectify. With universal publicly financed healthcare, we would reduce the need for expensive hospitalizations, and emergency room visits by preventing disease and treating conditions earlier.

We would support the 61.6% of Vermonters who visit a primary care physician, not a specialist, when they access care in the last year. And we would create stability to take away the unfair questions that I and many people like me have to ask. Should I scrape together the funds to buy my prescriptions out of pocket, or should I use that money to make my car safer to drive?

Should I drink lots of fluids and Google how to treat my symptoms, or should I spend hundreds of dollars to have it checked out by a physician? Before I lost my insurance in December, my doctor told me the warning signs of polycystic ovarian syndrome worsening. I'm scared that when this happens there won't be anything I can do about it. This community has welcomed me with open arms, from the small business owner who replaced my holed shoes, to the coworker who opened her home when I had nowhere else to go.

Vermonters have consistently shown themselves to be a community which values the well being of many, over the profit of few. Our healthcare system should reflect that same standard. We started toward that goal with the passage of act 48, an act which seeks to make healthcare a public good. Let's continue together. I am proud to be part of this community, and am grateful to add my voice to those in support of S53 and H248. Thank you.

Barbara Wilson: My name is Barbara Wilson and I own a small dairy farm and jamming business in Shoreham Vermont. I'd like to start my testimony by thanking the senate and house committees for setting up this opportunity to testify on behalf of primary healthcare access. Over the past five years, my husband and I have seen our healthcare insurance go from a $550 annual deductible to a $4,800 deductible, along with an overall increase in our annual premiums.

In 2018 our premiums plus deductible will total just under $18,500. Compared to five years ago, the cost has gone up over $5,600 representing over a 44% increase. When I originally started my small business right after my former employer stopped covering retiree healthcare, I was hoping I could earn enough to make up the difference. Unfortunately with the escalating costs, this is not possible.

We have the option to pull from our retirement savings, but it does raise the question, will our savings run out before we die? Sadly, many Vermonters that I know are facing an even worse situation. They have no health insurance at all, or they are paying high premiums for a plan that you have even higher deductibles and copays than we do.

To put this into perspective, according to health connect plan comparison tool, the estimated yearly healthcare cost of a very good health two person household with an annual income of $65,000 is between 22% and 42% of their annual income. It appears that for a medium income Vermonter between the ages of 45 and 64, their only option is to purchase a bare bones plan and not use it unless a catastrophic health event occurs, or simply go without.

I have to believe that there are large numbers of Vermonters who are self-employed, or work for a small company without healthcare benefits that are faced with this reality. When we don't have insurance, or when we have inadequate insurance with high deductibles and copays. I know first hand that we tend to put off going to see our primary care doctor until health problems become much worse.

All too often, ignoring health issues ultimately require much more care and much higher expense. A little over five years ago I had little reason to rationalize my symptoms away, and sought immediate treatment without delay. Given today's out of pocket healthcare costs, the outcome most likely would have been different.

Unless we start now by passing S53 and H248, preventable healthcare costs will continue to become even more expensive each year, resulting in many families including mine, deciding not to purchase insurance or being forced to purchase even higher plans. If we don't act now, Vermonters will pay the price with their finances or healthcare, and even their lives. Thank you.

Speaker 2: Thank you.

Millard Cox: My name is Millard Cox, I want to thank you for this opportunity. The healthcare system that we have now just like the entire economic system we have, is built to favor people with money. It's built to favor the rich. Poverty and poor health are inextricably linked. The causes of poor health are rooted in political, social, and economic injustice. Poverty is both a cause and a consequence of poor health. So here we are again, I don't know how many times I've been here. But we come back every year asking for a different, more humane, more rational healthcare system for the people of Vermont.

Every year we come here with the same request for the good of all of us who live in Vermont. But I wonder if our voices count. Do they carry the same weight as the voices of the insurance companies? Of the pharmaceutical companies? Of the medical corporations? Will you hear us this time? I support grading publicly for finance primary care for all the people in Vermont. And I would like to see Act 48 enacted eventually. The sooner the better.

I support removing the insurance corporations such as Blue Cross Blue Shield from involvement in the Vermont healthcare system. Since these corporations do not provide healthcare, and in fact they make healthcare more expensive and less accessible. Please take this step to remove healthcare in Vermont from a profit-driven market based system, and take us to a system in which healthcare is considered a universal human right, and a public good. Thank you.

Kayla Andrews: So hello, my name's Kayla Andrews. I'm a parent with a disability and in need of healthcare. I have been without healthcare for a year now. My health has been dissipating for months. It is hard to take care of my children when I am not able to care for myself and get my needs met. I have not been able to access a healthcare provider. I fill out paperwork at different doctor's offices and then wait for responses. It is frustrating when you get a letter in the mail from the doctor's office saying, "We cannot meet your needs because our care cannot take on your complex requirements."

And I say to myself, yeah, you're right. I have needs that are complex, but they wouldn't be if doctors would do their job, and not make comments about my disability and make me feel like I'm stupid and I don't know my own body. Because I'm not able to get a doctor, I'm at a standstill on getting services so I can be a parent and live independently. I'm also unable to get my health in order.

There has been times when I've been so weak and lightheaded, and dizzy that I'm unable to care for my children myself. I can't even get around my apartment or the community without falling or being unable to walk. This can last weeks, and now I'm struggling to eat. I am used to not walking well, being visually impaired, hearing impaired, ADHD and PTSD. For the last two to three years I've been struggling. I've been strung around and referred to the wrong doctors who don't specialize in cerebral palsy.

Now since I've been without a doctor for over these years, I am not being met. If I get sick, I am at home battling it myself. I have kids to care for, I have volunteer work to do, and school now. I don't have any free time to take off months because I get sick, and I am unable to get well. My children are growing up fast, and their needs are being affected by this. I am not able to take them outside, read to them, or get them what they need. It is not fair for my five year old to tell my son what he can and cannot do because she has to be the head of the household when I'm sick all the time.

Another issue I have, is my insurance telling me I cannot see a doctor. It's unfair that doctors are able to pick out who they choose to care for and who they don't have to care for. We need to have universal healthcare for all human kinds, not just the ones that are easy to fix, and leave the ones who are too complex to care for. No doctor or office should be able to choose who they think they can care for. No healthcare insurance should tell us what doctor to see, or who we can't see. If they accepted our insurance then we should be able to see these doctors.

Amanda Shepherd: My name is Amanda Shepherd. I'm a mother and a home care provider in Addison County. I struggle to get access to the care that I need beyond my primary doctor. Too often, I get referred to a specialist that requires out of pocket expenses, or a specialist that my insurance doesn't cover. Me and my clients, we are told what the best course of action is, and then we find out because we're on Medicaid it isn't covered. We go untreated.

Recently, my son was diagnosed with abnormality in his foot that was interfering with him walking and wearing shoes. We were told it was a cosmetic issue, so it wouldn't be covered through insurance. We would have to pay about $500 out of pocket for home treatment. Six months later I'm told by a foot specialist that the problem should've never gone this far, and that if we had better healthcare coverage it would've been covered.

Primary care for me has been hearing that I have a medical issue, and that my insurance won't cover it. That's really hard. I fought hard, work with thousands of people just like me with legislators like you, to pass Act 48. And there is no need to wait any longer. I want you to implement and fully fund a truly universal healthcare system that doesn't set limitations on how we receive care.

I want a system that makes it so that I can afford to care for myself, my family, and my loved ones. I'm part of the Vermont worker's center in Addison county, and some of our members, we met with Senator [Adams 00:29:54] about a month and a half ago to discuss the importance of the public hearing like this. Because with all the uncertainty and fear out there about healthcare, we need to be talking about solutions that get to the root cause. So thank you for listening.

This is not a problem for each of us individually. It is a problem for all of us, collectively as a state. You are in a position to lead the nation. Every day we hear about cuts, threatening Medicaid and other healthcare programs. We must move to a universal system. Vermont's economy and working people can't afford to be deprived of healthcare, so insurance companies can keep up their profit margins. You are the leadership, you are the leadership to move us forward. You can stop this crisis from getting worse. Thank you.

Ellen Schwartz: Hi, my name is Ellen Schwartz, I'm from Brattleboro Vermont, and I'm grateful that when I was a much younger person there was a movement of people who organized to create Medicare and Medicaid, so that people in my age range and people with disabilities and people who were poor would have some. Though, as you heard tonight, not all access to care. I'm on Medicare, which means that I have access to primary care, and much though not all specialist care.

I'm also fortunate enough to have been a public employee for the state of Massachusetts, which enables me to purchase an extension plan, a supplement that makes up the 20% on most of the care that Medicare covers. In a twist of irony I found out this week that my supplement was on the chopping block, and at this very moment there's a hearing in Massachusetts that I'm not at because I'm here about that very supplement and about their desire to cut those supplements.

But why am I here tonight if I've got such good coverage? My most serious and recurring healthcare problem over the last 10 to 15 years has been skin cancer. My primary care physician referred me to a specialist for this. Because Medicare covers specialist care, and because of my supplement, I've been able to access treatment and regular checkups with my dermatologist to catch any new cancers and pre-cancers early on.

As a result, none of my skin cancers has developed into life threatening disease. This is great for me. It's how our healthcare system should work, but not just for me, it should work like that for everybody. What brings me here tonight is that having a proclivity towards skin cancer which requires regular monitoring by a specialist, I can't help but think about people who don't have access to the care that I can access. Not necessarily for skin cancer, but for some illness that they may need treatment for.

In a moral and humane healthcare system, a person shouldn't have to qualify for healthcare by being old, or by having an employer who offers comprehensive health insurance, or by being able to afford an individual policy. A moral and humane healthcare system wouldn't be a patchwork where even those who do qualify for care face barriers such as high deductibles, or limits on what kind of care their insurer would cover.

A moral and humane healthcare system would be about human health, not profit for insurance companies, or hospital conglomerates, or for pharmaceutical corporations. Our humanity should be the sole qualifier for access to healthcare, including but not limited to primary care. It is simply unacceptable that someone like me wins the healthcare lottery, while others suffer or even die.

This is why I urge the legislature to fulfill the promise of Act 48, by designing and funding, fully funding, a healthcare system that treats healthcare as a public good, and guarantees all Vermont residents access to all needed care. Thank you.

Manny Mansbach: Hi, my name's Manny Mansbach, I live in Athens Vermont, and I'd like to thank the committee members for holding this hearing. Far too much of the public dialogue is about listening to what health industry executives and bean counters think about financing. While far too little is said about what's actually needed by real people. We are a can-do nation when it comes to many things, but not so when it comes to something as basic and as crucial as figuring out how to provide humane and effective healthcare, yet.

In 2012 at age 52 with a very good health history and many more good health habits than bad ones, I found myself in and out of the hospital three times in five weeks. Through no fault of my own, I'd contracted a common virus that led to a dangerous if untreated, inflammation of the fat surrounding the heart, known as pericarditis. I was able to receive very helpful lifesaving emergency and followup care, and I came out okay in the situation and was told I'd have no greater chance of developing heart disease than the average person.

I was fortunate to have lived in Massachusetts at that time, and had I not been enrolled in Mass health at the time, in addition to my medical problems, I would have been in a world of hurt financially, as the ordeal involved a number of very expensive procedures in addition to the cost of several days in the hospital. While access to universal primary care is very important, it wouldn't have helped in my situation.

The pericarditis gave no warning, and came on suddenly and strongly. Of course, this isn't just about me, I'm just one lucky guy who's still alive to use this breath and however many more I have to insist that we fulfill the promise of Act 48 and fund the system that treats healthcare as a fundamental right for every Vermonter, no matter who they are, or how privileged they are, or aren't.

A system that has barriers to access is not a healthcare system, it's a health denial system. We can and must do much, much better. We ought to properly fund Act 48, it's a matter of life and death for many, and quality of life for all. Our governor talks a lot about the problem of the shrinking workforce in the state. I know far too many people who are employed part-time who are reluctant to work more because they're afraid they'll lose their eligibility for Medicaid. This breaks my heart.

I feel confident that when we fund Act 48, Vermont will become a much more attractive place for young families to put down roots and help rejuvenate Vermont. Thank you.

Will Bennington: Good evening, my name is Will Bennington, I live and work in Plainfield, a career farm worker, and a member of the Vermont worker's center. I'm actually going to read something from my friend written today, from Renee, from Barry, who's too sick to be here tonight. Hello my name is Renee. I'm a 61 year old homeowner in Barry Vermont. I've been continuously diagnosed with multiple spinal degenerative diseases, COPD, various other illnesses as well.

I've had numerous neck and back surgeries beginning at 30 years old, and I'm presently in need of several more surgeries on my back and neck that I cannot afford. I'm also suffering with CDIF for the third time in the past year and a half. CDIF is a super bug infecting the colon and the intestines, and is a very deadly disease that is most often found in elderly and folks considered high risk.

Due to my illness, I have asked that my statement be read tonight so that I can share my story. I was a hardworking single mother, supporting myself and three children through adulthood without any child support. My work history is colorful, I'm a self-made independent woman who worked as an artist throughout my life. I spent a decade working with disadvantaged teens through Washington county mental health service. I busted my way through cosmetology school and worked as a hairdresser in Barry. I worked as a custom art framer. She has a whole list of things here, I won't get into them, for time sake.

For the past six years I've lived on $846 a month from social security and disability. This is obviously not enough to pay my bills, let alone my medical needs, food, gas, and heating fuel to name a few. I am in credit card debt because I am a homeowner, because of an IRA which wasn't much, I was just over the limit a few years ago and not eligible for fuel assistance, food stamps, Medicaid, et cetera.

That IRA ran out November of 2017. I've struggled before, and I have no choice but to apply for these benefits once I get my tax returns done this year. However, even with these benefits because I am in credit card debt, and I have no means to pay the debt back or have money to do upkeep on my home, I will be selling my home this coming spring. Selling my home will put me in the position of using any money left after paying my debt to survive on.

If my math is correct, I'm lucky if it will take me two years to be right back where I am now, this time without my home. I have the added burden of caring for my adult son, who has MRSA. He spent from May until October at UVM medical center, having multiple surgeries removing bones and tissue because the MRSA entered his marrow.

He continued ongoing treatment for MRSA, hospital visits, home health visits, and he cannot physically work for up to the next year, possibly never. We both struggle with illness and not having enough money to pay food or bills. My son almost his life in July due to MRSA, and if it wasn't for Medicare I would most likely be dead myself. Both of the diseases we suffer from are extremely serious and deadly illnesses. Anyway, there's a lot of good stuff in here, I'll give you the testimony. Lots of credit card debt and medical debt.

I'm asking that Vermont lawmakers continue to fight for the healthcare needs for all Vermonters. I'm asking you to diligently work towards a healthcare system for all, including disabled people like myself, my son, the elderly, and low-income people who should not have to sell their homes or not pay their rent in order to buy food, so that they can afford the healthcare they need. Thank you. And who can I give this to?

Speaker 2: You can submit the full testimony to one of our committee assistants. Thank you.

Sue Deppe: Hi, thank you for being here tonight, I know it's a long day for legislators. My name is Sue Deppe, I'm a psychiatrist in Colchester. I'm also representing the Vermont Psychiatric Association as the chair of healthcare reform for that organization. You guys don't have to be told that untreated mental illness, substance abuse, and untreated medical things take an enormous toll on society, and you see it in budgets.

Universal primary care is inexpensive, the payoff is enormous. Reduced suffering, which I think we're hearing about tonight. Lower mortality, this is all well documented and researched. Better health and lower costs. Investing in primary care improves health and lowers costs. Rhode Island mandated an increase in primary care spending from 5.4 to 8% of their healthcare budget for four years. The overall costs dropped 18%.

Other taxes would drop under universal primary care. Let me repeat that, many other taxes would drop under universal primary care. What's happening to school budgets, because of healthcare costs? What's happening to town budgets? State employee's medical cost, Medicaid, corrections, and other human services would be impacted if we gave everyone access to primary care, mental health, and substance abuse treatment.

The other issue that we have grave concerns about in my organization is that finding both a primary doctor or psychiatrist in Vermont is becoming extremely difficult. When I started a practice almost 30 years ago, there were lots of us in private practice. Now, there are very, very few. Our workforce is collapsing because of lower reimbursement and massive administrative hassles. Who wants to go through all that to be told what you can do by an insurance company?

More people would want to practice here if we have a well designed, efficient, non-hassle primary care, mental health, substance abuse system for payment. In 2011 many of you know, several hundred medical doctors and students stood on the steps of this state house and told us that they would want to come to Vermont if we had a single payer system. The recruitment problem would be easier.

Publicly financed universal primary care is the only way to focus resources on prevention. That allows you to put the money where you want it. So as others have said, thank you for being here and please support H248 and S53, and let's live out the dream of H48, the bill from a few years ago for a single payer system. Thank you.

Bobby Rood: Hi, I'm Bobby Rood from Warren, and I work for Washington County Mental Health Services as a psychotherapist visiting elders in their home, elders [inaudible 00:43:42] who are home bound and unable to get help with issues related most often, to healthcare. About 50% of the people that I see, everyone I see is on Medicare, but at least half of them cannot afford a supplemental plan.

I had a woman call me today and say, "I'm going to stop seeing you even though I found it very helpful, because I don't have a supplemental plan." Fortunately, I was able to talk to her about having a sliding fee, but that's... it's difficult to provide, and it's part of what the designated agencies are all offering under budget cuts, they're having to make up the difference for people who cannot afford to pay for the health insurance that covers the services. It's a strange system.

Part of what I feel, is that we are really lucky to live in Vermont. We have an excellent legislature, we have worked out the bipartisan difficulties and seemed to be able to talk to each other and communicate about what's important. I think most of us here agree that healthcare is not a political issue, it's a human right. We all need it, whether we're Republicans, Democrats, or Independents.

And I know that I am weary myself about what will happen. I'm working long hours, I come home at night, I still have work to do. About 50% of my job has nothing to do with the people I see, and everything to do with documenting what I did, and making sure that health insurance companies are able to process claims.

So I support S53 and H248, and I hope that you will too. I think this is a huge step, and a courageous step, and we in Vermont are not afraid to take courageous steps to really look at the issue of who has access to healthcare. Some of the problems we've heard about tonight have to do with quality of care, that's a whole other set of problems. But let's just make sure that everybody in Vermont has access to healthcare, and that this bill would provide coordination of care, a medical home, would save money on unnecessary referrals, and provide security for all of us. Thank you very much.

Tev Kelman: Hi, my name is Tev Kelman, I live in Washington Vermont, and I teach English at Randolph Union High School. I appreciate having the chance to speak to you, and I'm especially gratified to see one of my former students, the gentleman from Brookfield, sitting at this table. Yeah. Seriously, I'm very proud. No matter what you decide to do in this situation. So speaking as a teacher, as a teacher I see the healthcare crisis every day in my classroom, and I'm going to zoom through this part of my remarks, because I think that others have spoken powerfully to the experience of families not being able to access care or struggling to afford their premiums.

So I'm going to talk about what that does to kids, because whether the problem is kids and parents not getting needed healthcare, or whether the problem is struggling to afford the healthcare that you have, it creates stress. And as we learned in the service last week, stress is a cousin to trauma. And what we're seeing at the school I teach at, is a huge spike in poverty, from 20% to over 50% in the time that I've been teaching, which is less than 10 years, since you were in 8th grade.

And it's also, we're seeing spikes in the number of kids with emotional disturbance and ACEs, and the opiate crisis is becoming very, very real in our community for a lot of our kids. So, all of that's going on, and the people that I work with are working extremely hard and feeling extremely stretched extremely thin to meet those escalating needs. I know this isn't the education committee, but healthcare in my view is at the center of this problem, because our current market-based healthcare system has this perverse effect on the resources that schools have to meet these increasingly... to serve these increasingly needy populations.

Schools are hemorrhaging money, public money, into the private insurance industry because of rising premiums. And that's leading less for education to serve the kids. So we're asking our schools and the teachers in them to do more with less, because healthcare costs are gobbling up a bigger and bigger share of the budget each year. And now our Governor's solution, I just read on Twitter, and he said something about the courage to think outside the box. But his solution is to cut 4,000 jobs from education.

We can't have that, we need our elected representatives to deliver on the promise of Act 48, which was made in 2011. I think universal primary care is pointing in the right direction, but I don't think it goes far enough, and I think that there are people in this room for whom it would not meet all their needs. So that's why the workers, myself as a member of the worker center, we're organizing for universal healthcare and full implementation of Act 48. And if you want to sign a petition, we're outside. Thank you.

Abby Lamay-West: Hi, my name is Abby Lamay-West, I'm from Lincoln Vermont. Honorable representatives and senators, Vermont's passage of Act 48 proves what we already know, healthcare is a human right. We know that it is a just, moral, and right thing to do, and it is the living embodiment of Vermont values. We know the failings of healthcare in the U.S., and we know the costs and benefits, and the economic return on investment for universal primary care.

So I will not repeat them here, but I will speak for those who cannot be here. For hardworking Vermonters who own small businesses, work tirelessly on their farms, or who scrape by working two or three jobs. For my sister who has bipolar disorder, who must have treatment to stay healthy and to stay working, who has earned her college degree, works full-time, and yet can't find permanent work that provides health benefits. For my mother whose chronic and disabling disorder forced her to retire early, losing her health insurance and her income. For my cousin who fell on ice just last week and severely injured her shoulder, who is not getting the doctor recommended MRI because she's being laid off in two weeks and won't be able to afford it without insurance.

For my dear friend who is a nurse, who as she got closer to retirement age, could no longer work the demanding hours of a full-time hospital floor, she retired early, losing her healthcare. She still works per-diem three to four days a week, and her husband works as a handyman. They don't have health insurance because they can't afford the $1,000 a month premium and $13,000 a year deductible. They would have to spend $25,000 a year to get a penny in coverage.

Health insurance does not mean equal access to healthcare. For my friend who thought he just had a bad chest cold, who didn't go to a doctor because he couldn't afford it, who finally decided it was bad enough to go the ER where he was diagnosed with pneumonia and died within 24 hours of admission. He died, he died because he couldn't afford to see his primary doctor. That is the one and only reason. He died because the foundation of our healthcare depends on corporate insurance companies whose legal mandate is to make profit for its shareholders.

They have a vested interest in people living shorter lives, and not insuring the elderly, sick and infirmed, and paying the least possible amount to service providers. These profiteers hold our lives ransom. It is repugnant, and we all know these stories, we hear them all the time, we are living and dying in this reality every day. Every single day our families suffer, our friends die because they can't afford to see a doctor. Life or death should not depend on dollars, and it is within your capacity to fix this.

I urge you to remember that we are not just numbers on an insurance company's bottom line, we are not year-end profits that buy someone a second home. We are not bodies to be managed by insurance companies as a source of profit. We are people, living beings who suffer unnecessarily and die for no reason, and it is time for Vermont to stand up for Vermonters and to do what is right and just to move forward with universal primary care.

Speaker 33: Thank you senators and representatives for holding this hearing. I've been here before, I've been working hard with you for more than 10 years on healthcare reform, and while I'm happy to have the opportunity to be here again, I look forward to the day when we don't have to. I am not going to talk to you about my experiences as a nurse in Vermont for 30 years in trauma, general surgery, psychiatry, general medicine, and currently in cardiology at our level one trauma center in Burlington Vermont.

I'm not going to talk to you about the heartbreaking situations, the heartbreaking stories of patients that me and my colleagues see everyday. I'm not going to talk to you about what you already know, that primary care in the emergency room is a thing, and it shouldn't be. It's very expensive, and as my friend and neighbor Abby just described, it kills people when people wait to go seek healthcare until it's too late.

What I want to talk about is the context that we find ourselves in now, and I remember saying times before when I testified, that now is the time, this is the moment, this is the political moment and yet, I feel that way even more so now when we are getting the firehouse of attacks from D.C. when our governor here in Vermont wants to cut educator positions. When our governor in Vermont and others, are talking about for profit prison system. That's a huge concern to me. When property taxes are going up, and up, and up, and largely because of the cost of healthcare, of paying into health insurance.

So John, you're known to have something like when you try to pluck something or pull on something somewhere, you'll find that it's connected to everything in the universe. And I feel the same way about this issue, just as I mentioned, property taxes, education, healthcare is impacted, the cost of healthcare is impacting all of this. And in the environment we're all being impacted, many more so than others by the horrific policies coming out of D.C. right now. Now more than ever is the time for Vermont to do the right thing and move towards universal publicly funded healthcare.

Kyle Claus: My name is Kyle Claus, and I'm a resident of South Royalton, and I'd like to thank the committee for calling this hearing today. And I'm here before you to speak in favor of universal primary care. It should come as no shock to you that healthcare in this country is a nightmare, and it only stands to get worse. Americans pay more for healthcare than any other country in the world, yet we have the highest maternal and infant mortality rates, and the lowest life expectancy of any developed country in the world.

Healthcare costs are rising, and wages are staggering. In Vermont, community health centers are shuttering, and federal dollars are drying up. That's a problem because more than one-fifth of Vermonters get health insurance from Medicare, which congressional Republicans are sizing up with their hatchets as I speak to you right now.

We must prepare for a deeply uncertain future. So, let me say in no uncertain terms that a fully funded, single payer healthcare system is the only solution. As some elected officials have shown us, single payer will not fail for the wants of imagination, but for lack of courage. Ask yourselves this, do I have the courage to stand beside working people, or will I bend to the moneyed interests that wish to keep us dependent, wish to keep us sick, and wish to keep us impoverished. Whose side are you on? If your concern is cost, patchwork fixes only cost us more in the long run and we'll be no closer to the goal of health justice.

So let's set an example for the rest of the country. Just as this brave little state has countless times before. You have an opportunity to implement a system that does not extract profit from our bodies, for the enrichment of a few, but ensures stability for a working class, insurance applied. A system that does not punish the elderly, the poor, or the infirmed, but boldly declares that healthcare is a public good, and an essential human right.

Last week at an MLK day celebration at Vermont Law School, I was reminded of what Dr. King called the fierce urgency of now. The stories you'll hear tonight and have heard tonight are proof that we can't wait, especially with the stakes this high. We need single payer now. Thank you.

Speaker 2: [inaudible 00:58:36]

Alan Ramsey: Thank you, you put a scare into me for a minute there. My name is Alan Ramsey, I have been a family physician in Vermont for 38 years. I was an original of the Green Mountain Care Board and served for five years. I live in Essex Junction Vermont. I'm currently the medical director of the people's health and wellness clinic in Barry, Vermont. My patients at the people's clinic are either uninsured or underinsured.

Many have diabetes, heart disease or chronic lung disease, and some cannot afford their medications. They have medical problems that have gone undiagnosed, and unmanaged, and even cancers that could've been diagnosed at an earlier stage. This is all due to lack of insurance, or access to basic health services. Now with the gradual dismantling of the affordable care act, we expect a demand for our services to rise dramatically. Without the insurance mandate or cost sharing deductions, fewer Vermonters will enroll in Vermont Health Connect, and the re enrollment process for Medicaid may quickly lead to a reduction in access to this coverage.

Prior to the affordable care act, low income Vermonters had a safety net. Namely, the Vermont Health Access program, or the [inaudible 01:00:04] plan. We cannot resurrect those overnight, I fear [inaudible 01:00:12] will simply fall through the cracks and more will suffer, just as we have heard tonight. When I accepted Governor [inaudible 01:00:20] offer to join the Green Mountain Care Board in 2011, I knew I would be giving up the career I loved. As an educator and a family physician for the people of Colchester and Milton.

I did so because I believed in the basic principles of Act 48. I believe we have a moral responsibility to provide healthcare to all Vermonters. I knew that if we changed how we delivered healthcare services, and maybe how we paid for them, all Vermonters would be covered in a high quality system that would reduce the growth in costs. I still believe that is true, and Act 48 should be the foundation for healthcare reform in Vermont.

To that end, we have an opportunity to take the first steps towards fulfilling the promise of Act 48. A universal primary care program for all Vermonters would be just that step. Passage of this bill would mean all Vermonters have access to primary care services, regardless of their insurance status. There would be no copays or deductibles allowing Vermonters to access the preventative health services without fear of the cost.

If other problems were identified, they would still have their major medical coverage by commercial insurance, Medicare, and Medicaid. Others would still have the clinics for the uninsured, until we enact the full promise of Act 48. The simple and logical truth, the simple and logical truth is that we do not expect our car insurance to pay for the gas we need to run it. We should not have to rely on insurance to provide the primary care that we all need to stay healthy.

You will be debating many things during this legislative session, but there are only two things that impact all Vermonters, taxes and healthcare. It is time for you all to take a leadership role, we have not heard from the Scott Administration any meaningful approaches to increasing healthcare access for Vermonters. We are all depending on you for that, thank you.

Speaker 2: Thank you.

Karen Saunders: Hi, I'm actually Barbara's sister Karen Saunders. Barbara actually lives with too much pain to be able to make it up here, so she wrote this, I'll read it. And here we go. My name is Barbara Saunders. I live Brattleboro. I have a genetic connective tissue disorder called [inaudible 01:02:46] syndrome. For many years I was a special educator in Wyndham Southeast Supervisory Union. Several years ago, the severe pain that accompanies my mobility issues made it impossible even to do desk work.

This forced me to leave teaching, going out on long-term disability. Once I was on long-term disability, the school district no longer paid for my health insurance. I had to pay over $700 a month in order to continue getting my health insurance through COBRA. Coming up with that money each month gave me so much stress. I was so worried, because if I had been late with payment, my health insurance would have been shut off. I needed that insurance, not only for primary care, but also for specialists such as my rheumatologist, for diagnostic services such as MRIs, physical therapy, and for pain relievers and other medications.

I'm so lucky, because I had a bit of extra money and found a way to pay that insurance. So many other people in my position lose their health insurance, and find their health further deteriorating while waiting approval for social security disability benefits. Even once I finally got disability benefits, I found that some of the healthcare services that I critically needed weren't covered.

So I took teaching retirement several years earlier than I otherwise would have. I took a steep penalty in my yearly retirement income in order to get the teacher's retirement health insurance and healthcare I needed. My case is one of many that illustrate the need for universal access to all healthcare, not just primary care. I urge you to take the necessary steps during this legislative year to get us back on course with Act 48 and fully funded universal access to all healthcare.

Mary Chapman: Hi, I'm Mary Chapman, I'm from Middlebury Vermont. I'm a 57-year-old single woman. About almost two years ago I got really sick, and it took about six months to figure out what was going on. I have vesicular migraine, also known as vertigo, associated migraine. In that two years since I've been ill, I've accumulated probably about 30,000 debt in medical bills. And the choice I had to make, the choice I have to make, is do I care about my debt, or do I care about my health? Right now I care about my health more.

I'm now on disability, I get $800 something a month. How am I going to pay those $30,000 in debt? I don't have an answer, and I really don't care because I worked in the medical field and as my mom would say, you can't get blood out of a stone. It's sad, because this debt is going to affect everybody else. A lot of people like me live with bad credit, I'll never be able to buy a home, I won't be able to buy a car, I probably won't be able to rent an apartment, the list goes on.

So, what would you do if you were me? And I'm still looking at medical bills piling up. So thank you.

Dorothy Mamman: Hi, I'm Dorothy Mamman from Middlebury, and the last time I was here I think was probably about 16 years ago for the Civil Union debates, I see many of the same faces, so this reminds me of that, and I appreciate you coming to listen to Vermonter's stories, and I know this process works.

I'm going to just talk briefly about two perspectives. One is that I worked for 10 years as an IT support manager at a large corporation in Vermont, providing customer support for users of our healthcare billing software. I made a good living doing that, and the insanity over our insurance company was apparent to me every day. Billing codes, diagnosis codes, modifiers, primary insurance, secondary insurance, inpatient, outpatient, different requirements for every insurance company of which there were hundreds, often requirement completely opposite.

One required some modifier, the other prohibited that modifier, it's insane. We were a multi-million dollar profitable department for the company, but none of this money was actually spent on healthcare, this was all billing. We can't get a leg up on the ever increasing healthcare costs until we can address the 30% of healthcare cost that's wasted on the administration of insurance billing. So that's one piece.

The other piece is I retired early four years ago. Since then I utilized only preventative care until last spring. Then I had a small health issue, to me it was fever and chills that turned out to be an easily treated tick borne illness. Still, one doctor's visit plus the labs added up to $650, and that was with insurance. So I'm lucky that I could pay that, but I'm well aware of many who would find that prohibitive.

So I feel that it was enough to inspire me to skip the follow-up labs. I felt fine so I skipped them. For that kind of deductible cost and even copays are unaffordable to many people. A tick borne illness can happen to anyone, just a simple walk in the Vermont woods, and to me the treatment of that, being able to afford healthcare for something like that is a public good.

Left untreated this will cause loss of work time, more serious illness, organ impact, financial hardship, and a downward spiral. It's to all of our benefit that we all have access to good healthcare, and I think it's most cost effective if we take the insurance billing out of it and go with single payer. So I hope Vermont will make a start with universal primary care, at least. Thank you.

Leslie Ward: Hi my name is Leslie Ward, and I'm from Grand Isle. And my primary care doctor is a naturopathic doctor, and an [inaudible 01:08:59] on how fantastic naturopathic doctors are, and I just wanted to come here tonight to ask if you would include in these bills. I'm hoping it's just a little oversight and these are in there, because there aren't a huge number in this state and probably the percentage of Vermonters who actually use a ND instead of an MD is small.

I ended up at my naturopathic doctor, because I had gotten this respiratory... I had a really bad cold that settled into my chest and respiratory went on and on, and I ended up on a couple rounds of antibiotics and then I ended up with asthma, and I went to an allergist, and I was given a whole collection of inhalers, nose drops, eye drops, pills. And they worked. But I really didn't like taking all those things, and a friend of mine who was a MD at the time heard a naturopathic had gone and spoken to her class. She said check this out.

And wonder of wonders, I'm off all those medications and just by looking at my lifestyle and slowly weaning myself off the drugs and onto a more balanced diet and a few supplements. So I guess the other part that I want to point out is often times when I first went to the doctor she cured me of this whole asthma issue, and then it was like do I want to start using her as my primary care physician?

And my father was a doctor, so it was a little like naturopaths, just touchy feely. And so I asked her what if I come down with this or that and I need an antibiotic? And she said she would prescribe one. Was I crazy? But the number of times where she has referred me to other more traditional allopathic doctors for problems that I have had, but a naturopath is just so much more preventative medicine and I feel like I probably saved my insurance company and the state of Vermont an enormous amount of money because of the more actively healthy way I live my life now.

I don't wait until something's going to come up. NDs just really kind of work with you as a whole person, and keep you healthy, rather than what I consider the traditional doctor where it's you go with the problem and we get it fixed. I think that's also how most primary care doctors. So please include NDs in this, it's very simple you just have to add the little ND with the MD, and you'll make many doctors very happy. Thank you.

Speaker 2: Thank you. [inaudible 01:11:52] if you did not get testify or maybe someone signed up and did not get to testify and you have a written testimony, please share that with our committee staff and again [inaudible 01:12:24] drive safely and thank you for coming. [crosstalk 01:12:30]