(Host) In the Vermont gubernatorial race, Democrat Peter Clavelle criticizes what he says is Governor Douglas’s failure to offer real reform. Douglas responds that Clavelle’s plan to provide coverage for all is unrealistic and contains a hidden tax.
In the last of our series on issues in the governor’s race, VPR’s John Dillon has this report.
(Sound of coughing.)
(Clinic worker) “If you just drop the form off here that Monday night, I’ll have the doctor sign it.”
(Dillon) The People’s Health and Wellness Clinic in Barre is open two, sometimes three nights a week. There’s only one qualification for treatment: you have to be without health insurance. This is one of nine free clinics around the state set up solely for the uninsured. Business is booming.
(June Benoit) “When I started doing this position almost two years ago, we were not booked two weeks ahead of time. Now it’s not uncommon for us to be booked two weeks ahead of time.”
(Dillon) June Benoit is the clinic’s nurse case manager. As the number of Vermonters without insurance has swelled to about 63,000 – or about 10 percent of the population – more and more find their way to these cramped offices on the outskirts of Barre. In the past, the clinic added about 150 patients a year. So far this year, the clinic has taken on 323 new patients.
(Benoit) “We’re seeing many more patients, sicker patients because they haven’t had care. And often they’ve waited for so long so they come to us with pretty advanced high blood pressure or diabetes that they didn’t want to deal with. We’ve had people that have come in with lumps and things that should have been addressed but they didn’t have any opportunity to get them addressed and now they’re trying to get them addressed.”
(Dillon) The clinic relies on volunteer doctors. Nancy Chickering works as an emergency room physician at the Central Vermont Medical Center in Berlin. She also donates her time to patients in Barre.
In her regular emergency room job, Dr. Chickering also sees another side of the health care dilemma.
(Chickering) “I just know from the ER there is such waste in terms of people who don’t have health insurance coming to the emergency room, where at a minimum it’s $250 just to walk through that door – whether it’s for a strep screen, ear infection or whether it’s for an acute MI.”
(Dillon) In everyday language, an acute MI is known as a heart attack. Chickering knows that when people without insurance come to the emergency room, the bill often doesn’t get paid.
Hospitals write off these bills as bad debt or free care. But the care isn’t actually free. Instead, the costs are shifted over to those who can pay: the insurance companies and ultimately the businesses and employees who buy insurance.
(Peter Clavelle) “The number one reason that I’m running for governor is to solve a problem. The biggest problem that confronts Vermonters is health care.”
(Dillon) Burlington Mayor Peter Clavelle has targeted the cost-shift in his health care proposal. Clavelle wants to require every Vermonter to have health insurance within three years. The state would subsidize the coverage for small businesses and for people who can’t afford to pay. The idea is that if everyone is covered, the bad debt and free care gets wrung out of the system.
Clavelle wants to tap the $90 million that’s now spent on uncompensated care – like those emergency room visits people can’t afford – to cover the uninsured.
(Clavelle) “This is money that’s already in the system. And these savings will be recycled, will be kept within the system and will be used to make affordable health care for self-employed individuals, as well as small businesses. And the premiums, the cost of that health care, will be pegged to one’s income.”
(Dillon) The Burlington mayor has modeled his proposal after a plan passed in Maine. The Maine health care initiative is called Dirigo, Latin for “I lead,” after the Maine state motto. Maine Senate Majority leader Sharon Anglin Treat is a Vermont native who now represents Kennebec in the central part of the state. The Democrat says the criticism that Republicans raise in Vermont sounds familiar.
(Treat) “People will call something a tax just because they would like to make it look bad. But you know, it doesn’t mean everything is a tax. And, you know, indeed the amount we’re taking of that savings is far less than the actual savings that will be achieved by covering all these people.”
(Dillon) The Maine program was just launched this fall. But there are several big differences between it and what Clavelle proposed. For one thing, Maine didn’t make the coverage mandatory. Maine also jump-started its program with $53 million in federal Medicaid money. Vermont doesn’t have those kinds of funds available.
Chris O’Neill is a Maine state representative who chaired a special committee that drafted the plan. He says the federal money allowed the program to get started. The premium assessment – or tax – won’t be levied on insurance companies until it’s clear how much they’ve saved.
(O’Neill) “We were somewhat fortunate to have the federal moneys that came to help prop this thing up. I call it the $53 million training wheels. At the time that $53 million runs out, Dirigo will be a self-sustaining insurance product and naturally the claims have to be less than or equal to the revenues taken in. And if it gets out of hand, maybe we’ll have to go to Plan B, whatever that is.”
(Dillon) Both the Maine plan and Clavelle’s proposal are complicated because they involve a regulatory structure that will assess the savings obtained by insurance companies.
When Clavelle rolled out his plan in mid- September, he had a hard time explaining the financing. Republicans immediately launched with TV ads that used the mayor’s own words to devastating effect. The attacks obviously stung.
(Clavelle) “He captured on camera 20 seconds where I hesitated a bit in explaining the financial machinations of how this program would work. But Vermonters understand that he has hesitated for 21 months in office and has done virtually nothing – nothing! – to address the health care crisis.”
(Dillon) Douglas says he does have a plan, one that he believes is realistic and market-based. He wants to get more insurance companies to sell policies in Vermont. He’d like to give tax credits to small businesses that offer insurance.
The governor’s approach to cover the uninsured is on a smaller, more incremental scale than Clavelle’s. He’d use $18 million from taxes and other sources to offer subsidies to help people buy insurance. He says this would also whittle away at the cost-shift, because the group that he’s targeted gets the most free care.
In gubernatorial debates, Douglas warns that Vermonters should also be leery of government-required insurance.
(Douglas) “I hope we’re not going to send our understaffed state police out to issue citations for not having health insurance. Mandates don’t work.”
(Dillon) Although Republicans have criticized Clavelle for proposing a $90 million tax on insurance companies, Douglas’s plan also includes a tax. The governor would levy a 2 percent premium tax on Blue Cross and Blue Shield to raise money for expanded health coverage.
(Douglas) “I’m honest about it. He’s saying it’s $90 million, it’s free, it’s not a tax. I’m proposing to extend the premium tax, not increase it, but extend it to all players in the market.”
(Dillon) Douglas says Vermonters want more choice in the medical market. He supports health savings accounts that would allow people to save money tax free for medical expenses.
(Douglas) “There are a lot new products in the market now – health savings accounts that tie the revenue balance in an individual’s accounts to the cost of care and provide some incentive to reducing expenditures.”
(Sound of Barre clinic)
“People’s Health and Wellness, this is June…”
(Dillon) Clavelle says health savings accounts are fine if you’re healthy and wealthy. In between visits with patients, volunteer doctor Nancy Chickering says she’s amazed at how many people can’t afford even basic health coverage.
(Chickering) “I’ve just been struck since I first started working here how many people I see who I know from in the community in Montpelier who are fully employed, contributing members. And it shocks me to know that I sit on the side of providing care and they don’t have insurance. Because I just expect it – they’re working, their kids are in my classroom, they’re part of my community and it amazes me that health insurance is that far out of their reach.”
(Dillon) Thomas Brooks is one. The 55 year old lives in the Mad River Valley but travels to Barre to get care.
(Brooks) “I’ve been to college. I’ve been in the National Guard for six years. I was born in this country, I’ve had jobs with big companies. But now I don’t have health insurance. It’s an issue if anything were to happen to me.”
(Dillon) Brooks says government should take a bigger role in expanding health coverage.
(Brooks) “So I think it should be considered more of a right and less as a perk. They look at it now as a perk but really, it should be something you have an option to.”
(Dillon) In two weeks, voters will get their say on who they think has the best prescription for health care reform in Vermont.
For Vermont Public Radio, I’m John Dillon in Barre.