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‘A sense of urgency’: Sen. Bernie Sanders pushes Vermont health care players to high costs

A man in a suit speaks to several other people at a conference table.  Water bottles and nameplates are placed on the table.  A framed photo hangs on the wall behind him.
U.S. Senator Bernie Sanders, I-Vermont, speaks during the health care costs roundtable he hosted on Friday, May 31, 2024, in Burlington. Photo by Glenn Russell/VTDigger

Earlier this month, health insurers asked state regulators for permission to raise their premiums by about 9% to 19% — one of the highest increases in recent history.

That request sparked concern from residents, officials and lawmakers across the state — including U.S. Sen. Bernie Sanders, I-Vt.

“Individuals simply cannot afford large rate increases,” Sanders said in an interview with VTDigger. “Companies cannot afford a large rate increase. And we want to understand what’s going on and what we can do about it.”

That desire culminated in a roundtable discussion Friday afternoon in Burlington, where Sanders brought together some of Vermont’s top health care leaders — including the health commissioner and the heads of the state’s largest hospital and private insurer — to explain why care is becoming increasingly unaffordable.

In a wide-ranging and sometimes tense conversation, Sanders urged participants to drive down costs, repeatedly asking, “What are we doing?”

A man in a suit speaks in a meeting, facing another person in a blurry foreground.
Dr. Jeff McKee, CEO of the Community Health Centers of Vermont, speaks during a roundtable discussion on health care costs hosted by U.S. Sen. Bernie Sanders, I-Vermont, in Burlington on Friday, May 31, 2024. Photo by Glenn Russell/VTDigger

America’s health care system is “a broken, corrupt system,” Sanders said. “What can we do here in Vermont?”

Attendees included Steven Leffler, the president and chief operating officer of the University of Vermont Medical Center; Don George, CEO of BlueCross Blue Shield of Vermont; Jeffrey McKee, the CEO of Burlington’s Community Health Centers; Owen Foster, the chairman of the Green Mountain Care Board; and Mark Levine, the state health commissioner.

Gina Akley, the president of Barre-based stoneworking tools company Trow and Holden, was also on hand to explain how the rate increases would impact her business.

Akley told attendees that employees had the choice of taking company health care plans or receiving extra pay to purchase their own health insurance. She said the company, which brings in about $3 million a year, will spend about $200,000 this year on all those costs combined.

“The cost is prohibitive,” Akley said. “And because I’m a union shop, I have no real bargaining power when it comes to lowering my costs.”

Amid a tangle of statistics and jargon, healthcare leaders offered reasons why healthcare in the state is so expensive and growing.

“Healthcare costs are rising faster than anywhere else in the country,” Foster, president of the Green Mountain Care Board, told participants. “Meanwhile, access is limited and health outcomes have not improved. They stood still for the most part. So we are spending more and asking Vermonters to pay more, but we are not seeing the desired results from that investment.”

Participants offered several explanations for these increases and health outcomes. George, the CEO of BlueCross BlueShield Vermont, pointed to what he called the “deterioration in health status” of many of the company’s approximately 200,000 customers.

A woman with short hair and glasses, wearing a black blazer, speaks in a conference room.  In the foreground another person is partially visible holding papers.
Gina Akley, a small business owner from Barre, speaks during a roundtable discussion on health care costs hosted by U.S. Sen. Bernie Sanders, I-Vermont, in Burlington on Friday, May 31, 2024. Photo by Glenn Russell/VTDigger

Essentially, many people insured under BlueCross BlueShield have become less healthy, George said, “causing an increase in the proliferation and use of prescription medications, an increase in the use of medical services, and certainly an increase in the use in the more intensive health care. healthcare services.”

UVMMC’s Leffler cited shortages of nurses and other health care providers, expensive prescription drugs, a shortage of long-term care facilities and an aging population.

“We need more younger Vermonters who require less health care, are not on medications and do not have chronic diseases,” Leffler said. “We see and feel that every day.”

McKee, the CEO of Burlington’s Community Health Centers, offered some reasons why primary care providers were struggling: low reimbursement rates for Medicaid and Medicare and wage competition from UVMMC.

“Every time they have a union negotiation, I cringe and I look, and I think, how the hell are we going to hold up?” McKee said. “And how am I going to retain my staff?”

And Levine, Vermont’s health commissioner, pointed out that Vermont ranks high in national health rankings, but noted that the state is still grappling with some of the downstream effects of the Covid-19 pandemic: homelessness, substance use, mental health issues and delayed health. concern.

“Every person (in the hospital) is much more complex than they were five years ago, or 10 years ago,” Levine said.

During a meeting, several people sit around a conference table.  A man in the foreground gestures as he speaks.  Another man in the middle listens attentively with folded hands.
Vermont Health Commissioner Dr. Mark Levine listens during a roundtable discussion on health care costs hosted by U.S. Sen. Bernie Sanders, I-Vermont, in Burlington on Friday, May 31, 2024. Photo by Glenn Russell/VTDigger

Identifying the cost drivers is one thing; repairing them is of course something else.

Health leaders mentioned several workforce programs underway to strengthen the ranks of nurses and other health care providers. Levine pointed to the state’s application for the AHEAD model, a federal health care reform program that aims to reduce hospital spending and invest in primary care.

Foster of the Green Mountain Care Board pointed to recent legislation that eliminates prior authorization for primary care and directs the health care board to create a prescription drug affordability program.

And, he added, the board is taking a close look at how much insurers pay primary care providers, hoping to make it a more attractive career path and ease pressure on hospitals.

“We need to respect primary care for what it is, which is one of the most important medical professions,” Foster said. “And I don’t think we necessarily do that as a society.”

However, Sanders repeatedly expressed frustration with the pace of those efforts.

“I just don’t feel like there’s a sense of urgency,” he said.

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