 Alright, so the internal mic is actually on my camera. Alright, I'm tapping it Hello Chris, can you hear me? Wait three seconds You're certainly getting audio at the camera now. I'm seeing the meter jump really high Okay Testing testing Alright, so we're seeing the meter jump really high And there's two over there Alright, but I have a signal so that we can do it Then we should ask them to come in and that's it Where's the uh, the camera? Alright Hello Janet, is this on? Janet Oh it is on now Err, me When you call us first, testimony Are you going to call us by neighbor number? Because we don't know our number Okay Thank you Is this one good? I'll use this one Good evening Thank you everybody for coming tonight This is a joint hearing Of senate health and welfare And house health care We've invited you here To talk to us about Issues with access As you know, at least in senate health and welfare We are considering a gift bill Called universal primary care Looking at a way that we could arrange For everyone to have access To primary care and so we're interested In hearing your experiences To getting in the door for health care For those of you who haven't been here Before, we have a sign up sheet Um, Lori, where's the sign up sheet? They're out in the hallway Out in the hallway We will be calling To go up and testify And Lori One of you that goes Over three minutes And when you have 30 seconds left It'll light up and give you a warning You'd be amazed how much you can say In three minutes We'll also announce the person Who's on deck to take a seat And the red chair over here That way the transition is faster More of you will have a chance To speak and tell us What your issues and hopes are Also We ask that you do not applaud Your boo, his cry, whatever it is Don't throw things It just takes away time from people Who want to testify and we understand You're all here because you care a lot About this issue I'm going to hand it over to Representative Lippert He's the chair of House Health Care 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 What I'd like to Let me also mention that While Claire's committee is taking Up a bill on universal primary Care, our committee is also Involved in looking at Issues of affordability Hearing from the office of the State And looking at issues that are Impacting for Monter's Access to health care I'm tempted 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 a statute act Which is state law Which talks about access to Universal health care for all of Our Monter's 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 Live in or represent and if we Can quickly use this to go around I think it would be good for you to Know who we are. And coming from a senator from Washington County. And Donahue representative Northfield and Berlin. Lori Hooten representative Ethics Junction. Brian Chiena representative From Burlington. Dick McCormack I represent the Windsor County Senate President Hansis representative From Bradford. Ann Marie Christensen from Representative from Chester. Wethersfields and Cavendish Sorry. Ben Jickling I'm a representative from the Randolph area. I'm Tim Brighlin I'm a Representative representing Norwich, Thutford, Stratford and Sharon. Representative Doug Gage from Stratford. Senator Jenny Lyons representing Chitman district. Senator Debbie Ingram also from Chitman district. And I should have mentioned Most of you may know someone who Wish they could have been here Didn't dare make it because of the Roads or whatever. They can email us their testimony And we will be happy to post it Online as well as read it. We have more people than we Have. So if you are able to Condense your speech to less than Three minutes, it's more likely That someone else will be heard. So I'm going to give the hand of Representative Lippert because he Has that radio voice and he'll Get us all going. So, yes, thank you for Dialing in today. But we'll get the show going. So our first witness this Evening is Heather Pembroke And we have two people on deck. And we have a chair. I think you can It's actually a little couch. But I think two of you can share That. And on deck is Jill Charbonneau And Lorraine Halleck. And after each witness we'll add The other on deck folks. Hi, my name is Heather Pembroke And I live in Huntington, Vermont. I have three points that I'd like To make today. One from the past, one from the Present and one from the future. Looking to the past, I'm the 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 health care. 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 health care should Not profit margin and not made by People who have no medical training. My second point involves the Present. 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. This is state of Vermont Employee, I have the same health Care 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 Health care plan. My husband now struggles with A communication disorder called Aphasia, which is the same Communication disorder Gabrielle Giffords acquired when she was Shot. When the part of the brain responsible For communication is damaged, you lose This debilitating condition can Improve dramatically with Speech therapy and yet our Health care system, mine and Yours. Arbitrarily caps therapy For both speech, occupational And physical treatments, Regardless of the need, regardless Of medical professionals' 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 Health care systems. The Austrian health care system is Superior to the Americans and it Costs about half. It's about $4,500 per capita while 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 towards a future where We'd have better health care and Thank you for your time. Thank you. Our next on deck Witnesses, Ethan Park. This is Jill. 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 In an hour and still people would Find health care beyond Their touch even with insurance as We just heard moments ago. I was heartened to hear Testimony from Dr. David Reynolds that, you know, It's possible to utilize the Federally qualified health care Program already in existence In Vermont to spread this Program. And I also believe Dr. Alan Ramsey said that we Have the experience in To administer this program. So I hope we can get around Ourselves and get over the Barriers and really move this. I like Dr. Reynolds's idea because I think it could move across the United States in that manner. And lastly, I would say that Taxpayers have Foot the bill for the medical Industrial complex and they're The real reason why we don't Have adequate health care and I Hope this state can take a Look at people can get the care They need. Thank you. Thank you. Next we're from Lorraine and The next on deck witness is Lois Whitmore. 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 Health care which to a lot of People isn't a lot. It's a Lot of money with a $5,000 Deductible. I can't do it, you know, 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. And I think that's one of the Young people, old people in Between. No one should go without Health care 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 health care. That's all I have to say. Thank you. Thank you. Our next witness on Deck would be Sandra My name is Ethan Park 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've done in recent years. Universal publicly funded Pre-K. In my opinion your record is Very good on health care. I'm 67 years old. I've worked all my adult life. I'd like to scale back and do All the things 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 I have been in favor of universal Publicly funded health care 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 a bill introduced by Representative Paul Poirier and Senator Peter Welch to fund Health care for the uninsured Using a combination of payroll And income taxes. I hate to say this but 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 Said for universal primary care. Yet many democratic office Holders 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 Laws in the way and so forth. I've heard it all. Many of You are philosophically on board and I thank you. But Shallow understanding from people Of ill will 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 Of the government. 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. Thank you. Thank you. I'm going to ask people To refrain from snapping fingers Or As Much as you'd like to do that. This is a public hearing where we do not Have expressions of support Or opposition from the audience. Thank you for your support in that. Patricia Reed is our next witness on deck. My name is Sandra Pahn And I'm 64 years old. 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 Legislature Say We're going to give the state of Vermont Medicaid with no co-payments. Because Like I went to physical therapy today It would have cost me over $700 for one visit And that is not good. So And I live in also in Barrie, Vermont. And that's all I have to say. Appreciate your coming. Thank you. Our next witness on deck Is Barbara Wilson. Our next witness Is Patricia Reed, I believe. Okay, I'm sorry. Things got twisted around here. 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 is well trained and knowledgeable You get to see the right 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 lengthy appointment to another With repeated trips to the ER To different hospitals. Schedulars 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 a third Or was it the fourth ER trip To arrive at a diagnosis of a rare stage 4 cancer. Schedulars Who are currently centralized at UVMMC 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 STAT 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 delaying an inappropriate referral? Are there steps we can take together To protect and advocate for those we love Which will improve the employment 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 doctors' strategic communication? Can the Vermont Health Department Take the lead in statewide public Education of patients in 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 centers 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 licensed people For example, the state already Regulates the Vermont office Of professional regulation Barbers and cosmetologists Because they work in 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 centers should be accountable For their roles. Would my daughter's prognosis be the same As she'd been triaged properly When she first tried to get help? My daughter was triaged months of anxiety Pain, emotional and economic dysfunction. I urged the legislature To facilitate regulatory fixes And use its power of health oversight To study the prevalence of such tragedies And recommend strategic improvements. Thank you. Our next on-deck witness Is Millard Cox. Thank you for the opportunity To address this group in support Of universal primary care and bills In the state of Vermont. My name is Patricia Reed, And as the resident of Addison, Vermont, I am a newcomer to this wonderful Vermont community. There are some people here today Who have welcomed me to the Green Mountain State As co-workers and friends. I'm here to implore you members of the committee To welcome me 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% Underinsured. Underinsured means essentially that although I currently carry private health insurance, I do not access 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 Who have been hospitalized for illness Are fine 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 And also manage my polycystic ovarian syndrome. Something that, when gone untreated, Will affect my weight, my mood, And even my ability to have biological children. My anecdotes and the ones from others Speaking here tonight are indicative Of a systemic problem, a problem That we can begin to rectify. With universal publicly financed primary Care, 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 My primary care physician, not a specialist, When they accessed care in the last year. And we would create stability that would 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, I was a little scared of the Welfare 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 old shoes to the co-worker Who opened her home when I had nowhere Else to go. For monitors 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 To continue together. I am proud to be Part of this community and I'm grateful To add my voice to those in support Of S53 and H248. Thank you. Thank you. Our next on-deck witness is Kaya Andrews. My name is Barbara Wilson and I own A small berry farm and jamming Business in Charm 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 the community. My name is Barbara Wilson and I Am on the same session for a Under 10th century health care Success. Over the past five years My husband and I have seen our Healthcare insurance go from a 550-annual deductible to a 4800 deductible along with An overall increase in our Annual premiums. In 2018 Our premiums plus deductible Will total just under 18,000 500. number 5600 representing a 44% increase. When I originally started my small business right after my former employer stopped covering retiree health care, I was hoping I could earn enough to make up the difference. Unfortunately, with the escalating cost, 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 have even higher deductibles and copays than we do. We put, to put this into perspective, according to Health Connect Plan Comparison Tool, the estimated yearly health care costs of a very good health two person household with an annual income of 65,000 is between 22% and 42% of their income. It appears that for a median 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 health care 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 firsthand 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 have had little reason to rationalize my symptoms away and saw an immediate treatment for Lyme without delay. Given today's out of pocket health care cost, the outcome most likely would have been different. Unless we start now by passing S53 and H248, preventable health care 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, their health care, and even their lives. Thank you. Our next on-deck witness is Amanda Shepard. My name is Millard Kotz, I live in Ripton. I want to thank you for this opportunity. The health care system that we have now, just like the entire economic system we have, is built to favor people with the 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 health care 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 creating publicly financed 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 health care system. Since these corporations do not provide health care, and in fact, they make health care more expensive and less accessible. Please take this step to remove health care in Vermont from a profit driven market-based system and take us to a system in which health care is considered a universal human right and a public good. Thank you. Thank you. Our next on-deck witness is Ellen Schwartz. I have to do a different, why are you so... Why do I make this work, there we go. No, that's not going to work, so I'll just do it this way. So, hello, my name's Kai Andrews. I'm a parent with a disability and a need of health care. I have been without a health care for over a year now. My health has been dissipated for months. It is hard to take care of my children when I'm not able to care for myself and get my needs met. I have not been able to access a health care provider. I fill out paperwork at different doctor's office 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. I say to myself, yeah, you're right, I have no... 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 a 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'm so weak and lightheaded and dizzy that I'm unable to care for my children and 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'm 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'm not being met. If I get sick, I'm at home battling 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'm unable to get well. I don't, my children are growing up fast and their needs are being effective 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 health care 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 health care 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. Thank you. Our next on-deck witness is Manny Mansbach. My name is Amanda Shepard. 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 an 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 out of $500 out-of-pocket for a home treatment. Six months later I'm told by a foot specialist that the problem should have never gone this far and that if we had better health care coverage it would have 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, worked with thousands of people just like me and with legislators like you to act 48 and there's no need to wait any longer. I want you to implement and fully fund a truly universal health care system that doesn't set limitations on how we receive care. I want a system that makes it so I can afford to care for myself, my family and my loved ones. I'm part of the Vermont Worker Center in Addison County and some of our members we met with Senator Ayers about a month and a half ago to discuss the importance of for the public hearing like this because with all the uncertainty and fear out there about health care 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 health care programs. We must move to a universal system. Vermont's economy and working people can't afford to be deprived of health care 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. Thank you. Our next on-deck witness is Will Bennington. 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 are poor would have some, though, as you've 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 in 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 is 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 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 health care 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 precancers 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 health care 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 health care system, a person shouldn't have to qualify for health care 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 health care 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 health care system would be about human health, not profit for insurance companies, for hospital conglomerates, or for pharmaceutical corporations. Our humanity should be the sole qualifier for access to health care, including but not limited to primary care. It is simply unacceptable that someone like me wins the health care 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 health care system that treats health care as a public good and guarantees all Vermont residents access to all needed care. Thank you. Thank you. Next on Deck Witness is Sue Deppie. Hi. My name is Manny Manzbeck. 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 health care, 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 sac surrounding the heart known as pericarditis. I was able to receive very helpful lifesaving emergency and follow-up care. And I came out okay in this 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 a 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. Thank you. Our next on-deck witness is Bobby Rude. Good evening. My name is Will Bennington. I live and work in Plainfield, a career farm worker and a member of the Vermont Worker Center. I'm actually going to read something from my friend 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, and 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 am also suffering with C. diff for the third time in the past year and a half. C. diff is a superb bug affecting the colon and 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 hard-working single mother supporting myself and three children to 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 teams through Washington County Mental Health Service. I bust in my way through cosmetology school and worked as a hairdresser in Barry. I worked as a custom art framer and she has a whole list of things here. I won't get into them for brevity's sake. For the past six years, I've lived on $846 a month from social security disability. This is obviously not enough to pay my bills, let alone my medical needs, food, gas, and heating field 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 last few years ago and not eligible for field assistance, food stamps, Medicaid, et cetera. That IRA ran out in November 2017. I have 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 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 for food or to pay bills. My son almost lost his life in July due to MRSA and if it wasn't for Medicare, I would most likely be done myself. Both of the diseases we suffer from are extremely serious and deadly illnesses. Okay, ooh, gotta wrap it up. 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 health care needs for all Vermonters. I'm asking you to diligently work towards a health care 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 health care that they need. Thank you. And who can I give this to? Thank you. I was just going to say you can submit the full testimony to one of our committee assistants. Thank you. The next on-deck witness is Tev Kelman. Hi, thank you for being here tonight. I know it's a long day for legislators. My name is Sue Deppie. I'm a psychiatrist in Colchester. I'm also representing the Vermont Psychiatric Association as the chair of health care reform for that organization. You guys don't have to be told that untreated mental illness, substance abuse, and untreated medical things to 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 in research. Better health and lower costs. Investing in primary care improves health and lowers cost. Rhode Island mandated an increase in primary care spending from 5.4 to 8% of their health care budget for four years. The overall cost 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 health care costs? What's happening to town budgets? State employees' medical costs, 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 a psychiatrist in Vermont is becoming extremely difficult. When I started 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 low 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 had a well-designed, efficient, non-hassle primary care mental health substance abuse system for payment. In 2011, many of you know several hundred doctors and medical 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 H-248 and S-53. And let's live out the dream of H-48 or the bill from a few years ago for a single-payer system. Thank you. Thank you. Our next on-deck witness is Abby LeMay West. Hi, I'm Bobby Rood from Warn. And I work for Washington County Mental Health Services as a psychotherapist visiting elders in their home. Elders who are older Romaners who are homebound and unable to get help with issues related, most often, to health care. 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. Unfortunately, I was able to talk to her about having a sliding fee. But it's difficult to provide. And it's a part of what the designated agencies are all operating under budget because they're having to make up the difference for people who cannot afford to pay for the health insurance that would cover some of 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 seem to be able to talk to each other and to communicate about what's important. I think most of us here agree that health care 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 wary 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 unable 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 are in Vermont not afraid to take courageous steps to really look at the issue of who has access to health care. 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 health care. And that this bill would provide coordination of care. A medical home would save money and unnecessary referrals and provide security for all of us. Thank you very much. Thank you. Our next on-deck witness is Murray Cordes. Hi, my name is Tevia Kellman. I live in Washington, Vermont. And I teach English at Randolph Union High School. 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. So I'm also, yeah. Seriously, I'm very proud. No matter what you decide to do on this issue. So speaking as a teacher, as a teacher, I see the health care crisis every day in my classroom. And I'm going to zoom through this part of my remarks, because I think the 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 health care, or whether the problem is struggling to afford the health care that you have, it creates stress. And as we learned at in-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 eighth 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 I work with are working extremely hard and feeling stretched extremely thin to meet those escalating needs. I know this isn't the education committee, but health care, in my view, is at the center of this problem because our current market-based health care system has this perverse effect on the resources that schools have to serve these increasingly needy populations. Schools are hemorrhaging money, public money, into the private insurance industry because of rising premiums. And that's leaving less for education to serve the kids. So we're asking our schools and the teachers in them to do more with less because health care costs are gobbling up a bigger and bigger share of the budget each year. And now our governance 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 health care and full implementation of Act 48. And if you want to sign a petition, we're outside. Thank you. Thank you. Our next on-deck witness is Carl Klaus. Hi, my name is Abby LeMay West. I'm from Lincoln, Vermont. Honorable representatives and senators, Vermont's passage of Act 48 proves what we already know. Health care is a human right. We know that it is the just, moral, and right thing to do and that it is the living embodiment of Vermont values. We know the failings of health care in the US. 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, who's 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 health care. 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 health care. 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 to 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 health care 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 ensuring the elderly sick and infirm and in 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 family 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 your 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. Our next on deck witness is Alan Ramsey. 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 gonna talk to you about my experiences as a nurse in Vermont for 30 years in trauma, general surgery, psychiatry, med surgeon, currently in cardiology at our level one trauma center in Burlington, Vermont. I'm not gonna talk to you about the heartbreaking situations, the heartbreaking stories of patients that me and my colleagues see every day. Not gonna 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 wanna talk about is the context that we find ourselves in now. And I remember saying in 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 fire hose of attacks from DC when our governor here in Vermont wants to cut educator positions. When our government, governor in Vermont and others are talking about a for-profit prison system that's a huge concern to me when our property taxes are going up and up and up and largely because of the cost of healthcare, of paying into health insurance. So John Muir is known to have said something like when you try to pluck something or pull on something in 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 impact, the cost of healthcare is impacting all of this. And in the environment when we're all being impacted, many more so than others by the horrific policies coming out of DC right now. Now more than ever is the time for Vermont to do the right thing and move towards universal publicly funded healthcare. Our next on-deck witness is Barbara Saunders. Good evening. My name is Kyle Kloss and I'm a resident of South Royalton and I'd like to thank the committee for calling this hearing today. And I appear 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 stagnant. 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, a single payer will not fail for 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, who wish to keep us sick and wish to keep us impoverished? Whose side are you on? If your concern is cost, patchwork fixes will only cost us more in the long run and will 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 in short supply of it. A system that does not punish the elderly, the poor or the infirm 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. Thank you. Before we hear from our next witness and our next. Well, our next on deck witness is Mary Chapman but in the interest of the health and wellbeing of everybody in the House chamber I'm going to suggest that we take a stay in place stretch just so we can stand because we've been sitting a long time and we have a lot more sitting to do. Let's just do that for a minute or two and then we'll reconvene. Okay, let's resume. Ask people to be seated again please. Could we have your attention? Thank you and you can look forward to that again in about 45 minutes. So our next witness is Alan Ramsey and our two on deck witnesses are Barbara Saunders and Mary Chapman. Thank you. You put a scare in to 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 member 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 Berry, 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 have 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 the demand for our services to rise dramatically. Without the insurance mandate or cost sharing reductions fewer Vermonters will enroll in Vermont Health Connect and the reenrollment process for Medicaid may quickly lead to a reduction in access to this coverage. Prior to the Affordable Care Act the low income Vermonters had a safety net namely the Vermont Health Access Program or the Catamount Plan. We cannot resurrect those overnight. I fear more Vermonters will simply fall to the cracks and more will suffer just as we have heard tonight. When I accepted Governor Shumlin's 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 health care to all Vermonters. I knew that if we changed how we delivered health care services and maybe how we paid for them all Vermonters could be covered in a high quality system that we reduce the growth and costs. I still believe that is true and Act 48 should be the foundation for health care reform in Vermont. To that end we have an opportunity to take the first step 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 had access to primary care services regardless of their insurance status. There would be no copays or deductibles allowing Vermonters to access the preventive health services without fear of the cost. If other problems were identified they would still have their major medical coverage. By commercial insurance, Medicare or 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 that 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 health cares. It is time for you all to take a leadership role. We have not heard from the Scott administration any meaningful approaches to increasing health care access for Vermonters. We are all depending on you as we have heard tonight. Thank you. Thank you. Our next on-deck witness is Dorothy Maiman. Hi, I'm actually Barbara's sister Karen Saunders. Barbara 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 in Brattleboro. I have a genetic connective tissue disorder called Ehlers-Danlos 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'd been late for the 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, for 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 teacher 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 the 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. And thank you from Barbara. Thank you. Our next on-deck witness is Leslie Jacobson. Sorry, wait a minute. 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 forsticular migraine, also known as vertigo, associated migraine. In that two years since I've been ill, I've accumulated probably about 30,000 in debt in medical bills. And 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 and something a month. How am I gonna pay those $30,000 in debt? I don't have an answer. And I really don't care because I've worked in the medical field. And as my mama would say, you can't get blood out of a stone. It's sad because this debt is gonna affect everybody else. And 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. Thank you. Our next on-deck witness is Mary Gourish. Hi, I'm Dorothy Mammon from Middlebury. And last time I was here, I think it was probably 16 years ago for the Civil Union debates. I see many of the same faces. But so this reminds me of that. But I appreciate your coming to listen to Vermont's stories and I know this process works. I'm gonna 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 of our insurance company though, it 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 the requirements completely opposite. One required some modifier, the other one 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 what is it 30% of healthcare costs 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've utilized only preventive care until last spring. Then I had a small health issue. To me was as well 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 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. I feel that, and 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 co-pays are unaffordable to many people. A tick-borne illness can happen to anyone who takes 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 this 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. Thank you. Our next on-deck witness is Charlie Murphy. Hello, my name is Leslie Jacobson and I live in Bennington. And I'm a member of Rights and Democracy. I've lived in Vermont for 40 years, but this is my very first time inside the state house. I came here today because I believe our healthcare system is in crisis. Prices are out of control, insurance companies are a nightmare to deal with for patients and doctors alike. And not all Vermonters have access to or are able to afford the care that they need as we have heard this evening. I am a retired teacher. I have been fortunate to have good healthcare coverage. I'm healthy because of the good care available to me. But unfortunately, again, as we have heard here this evening, this is not true for all Vermonters. Just the other day, a friend of mine in Bennington was in line at the pharmacy. The person in front of her needed to have a prescription filled. When he was told the cost of the medication, he left it on the counter. He was unable to afford it. Was that a life-saving cancer drug? I don't know. But even if that medication was for a seemingly small problem, like a cut that had become infected or an abscess tooth, not taking the medication may have led to major costly complications. There are numerous stories to be told of personal hardships stemming from the healthcare crisis, but time is short this evening. So instead of relating additional accounts, I will emphasize what can be done to help alleviate this urgent situation. We need your support to implement Act 48, the Vermont bill that was passed into law in 2011. It is the bill that would provide necessary medical care for every Vermonter, universal care. It would include treatment for eyes, ears, opioid addiction, mental health and dental care. With healthier Vermonters, we will have a healthier Vermont. We would all benefit, medically, socially and economically. This is a moral imperative. Do we care for each other or not? Without our health, nothing else matters, and any one of us could face a catastrophic medical condition. There is a workable financial plan to implement Act 48, and I'd be happy to supply this to you upon request. Historically, Vermont has led the way on so many important societal issues. Help us add universal care to this list. Thank you. Thank you. Our next on-deck witness is Jessica Morrison. Relations. And I use this traditional, local degrading because the subject of health care is one that lends itself to that. We're talking about, we are all related. We're all human beings. We all suffer. We all have the frailties of human beings. And there have been a lot of articles in the press lately, don't know whether they're true or not, that say that our legislators feel that health care is not a priority for the people of this state this year. After all the things that are happening in Washington, Medicaid cuts, attempts to repeal the ACA, even things like no funding for CHIP, trying to cut Medicare, and work requirements for Medicaid that even our neighbor of New Hampshire is adopting. How could health care not be a priority for the people of Vermont? I know that you can embrace your common humanity. And I know that you've heard tonight and that you probably hear every day and may have personal experience with human suffering. We are all in this room, healthcare justice voters. We oppose all the cuts I just mentioned. We support Medicare for all on a nationwide level. In fact, very shortly in 10 minutes, Bernie will be starting a nationwide talk on Medicare for all. We support universal care here in Vermont. We support LGBTQ and reproductive healthcare. We support mental health care, care for substance abuse. We support paid family medical leave so that we can take care of our loved ones as we all know we should because we are all related. So as healthcare justice voters, we ask that you throw away the concept of scarcity, fear and austerity. We ask you to embrace the concept of abundance, humanity, compassion and justice. We ask you to let us hope you be healthcare legislators. Thank you. The next on deck witness is Tom Joslin. Just for everybody's information, we scheduled our hearing before Bernie scheduled his. Thank you for you to say. Sorry, shouldn't be editorial here. Good evening, my name is Charlie Murphy and I work for as a peer advocate counselor with the Vermont Center for Independent Living down in beautiful Bennington. My testimony is going to be a summary of three of the four written testimony that I brought with me tonight. My first peer is Tracy. Has waited years for a program called Medicaid for working persons with disabilities to take effect. It has, she applied for it and she was deemed ineligible because her asset level was over the amount that would allow her to be eligible for the program. She hopes to spend it down over the next year but meanwhile the high deductibles co-pays in the so-called Medicare Part D donut hole has presented her or prevented her from time to time to buy the necessary diabetes medication which recently resulted in her going to the ER to determine whether she had a stroke or a blood clot. My next peer is Angela. Angela is slightly over income for Medicaid, community-based Medicaid. She has to go through an out-of-pocket spend down to become eligible. She's eligible for six months and then she's off. While she's eligible, Medicaid pays for a Medicare deductible in co-pays and then she has to be off the program until she's eligible again and does another out-of-pocket spend down. One of the things that is affected as a result of this, among others, is her Medicaid-based transportation which she relies on for her numerous doctor's appointments. This instability coupled with other related stressors negatively affects her PTSD and her severe anxiety disorder. My next peer is Michael. Michael was hit in a crosswalk down in Bennington by a drunk driver and left for dead in the middle of Elm Street. He survived the accident with numerous injuries as well as a partial leg amputation. Over the years, he's needed dentures to help with the nutrition that he needs to keep healthy skin and heal wounds. Dentures can cost anywhere from $3,000 to $5,000. Depending upon the dentist you go to, there are other cheaper, less expensive options, but you get what you pay for. If finding funding for dentures is close to impossible, if not impossible. That's why I feel that our healthcare system is fragmented. It's a patchwork of programs. We need universal healthcare. Act 48 needs to be implemented fully and needs to be implemented fully and equitably financed, public financed and in closing I wanna say healthcare is a human right and thank you for this opportunity. Thank you. Our next on-deck witness is Ellen Oxfeld. I believe pretty short. I didn't prepare too many remarks, but my name is Jessica Morrison. I'm the member of the Vermont Merckers Center and I'm also a nurse practitioner at Trillium Integrated Medicine in South Burlington. I'm a primary care provider for some of my patients and I also do functional medicine and integrative medicine consults with patients with chronic complex health conditions. I really love what I do and I think we do something really special at our practice and I really want that care to be accessible to people. I hate it when I order labs or prescribe some other type of care and it's not covered by insurance. A lot of my patients have really high deductibles and co-pays and when they realize that they're gonna get a $500 bill from a couple visits, then they stop coming and that's the reality. And from my point of view, insurance company's main job is to deny care and waste my time, time that I don't have and I wanna be spending on patient care rather than prior authorizations and the hours of daily documentation it takes to get paid for our work. I think universal primary care could be a step forward and I'm pleased with the mental health coverage but I don't think it's enough. As a primary, as a PCP, I really can't do it alone. I do rely on referring to specialists in hospital care if that's what someone needs. I don't wanna say, oh, I think that went to cancer or some other serious illness and not be able to see that through with someone or that care might cost them a lot of money or bankrupt them. I think preventive care is really important but people shouldn't be penalized for not having the access to the social determinants of health that keep us healthy. It's not just medical care. It's a lot of other factors that keep us healthy. So yeah, I only, we can afford half measures or false solutions that don't get to the root cause of profit in our healthcare system. We need to get the profit of insurance companies, pharmaceutical companies who are profiting off of our healthcare. We have to finish what we started with Act 48 and fund it, fund it equably, publicly financed healthcare. We still have the bill in the books and we need you to, we call on you to have the courage and leadership to pass that and you have to do better for us as patients, as providers and everyone here in Vermont. So thanks. Thank you. Lauren, could I ask if you moved the microphone just to touch closer to the witness? I think it got moved back at one point. It was, it was hard to hear the previous witness. That's just keep adjusting it sometimes. Thank you. So our next on-deck witness is Walter Carpenter. Hi, I'm Tom Jocelyn of Jericho. The draft of H-248 from last year specifically excludes dental services from the legal definition of primary healthcare. Should that definition clearly include preventive dental care as well as vision screening and hearing screening? I'm asking because what happens to our teeth and gums and eyes and ears affects the rest of our bodies as well as our overall well-being. Thank you. Thank you very much. Our next on-deck witness is Tenzin Schupfel. Hi, I'm Ellen Axfeld from Middlebury, Vermont. I have good healthcare and a very good job. I have never ever understood or accepted that my neighbors and my fellow Vermonters don't have what I have for no reason other than that we have a crazy system. You've heard in an unfair system. You've heard in agonizing detail the suffering of Vermonters who do not have access to healthcare. I'm here to support H-248 and S-53, universal publicly financed primary care as a first step and essential step, a simple step and an inexpensive step. You know why primary care comes first. You've heard how it saves money and detects problems sooner. That doesn't mean it's the last step. We've heard all about that tonight. Why universal? Because this is a point other people have not yet raised. We Americans don't do very well with charity. We don't like to pay for other people if we're not suffering. That's a terrible thing to say because you've heard a lot about suffering tonight. But we Americans do very well with solidarity. When we're all in one pool together and we all have the same thing, we support it. When the rich people and the healthy people who are not necessarily in this room tonight in large numbers all have primary care from that same universal primary care trust funds that all the rest of us have it from, they'll support it. It's like social security. I don't wanna say untouchable because some people wanna touch it but it's hard to touch it because we all know we'll get it. That's why your first step in the implementation of Act 48 has to be a universal one. And why not start with primary care? Okay, second objection, complication. You guys have thought through all kinds of far more complicated things in the past few years. The Affordable Care Act is very complicated. Platinum, bronze, silver, gold, right? Subsidies, non-subsidies, qualifying, not qualifying. The all payer model, all payer model and the ACOs post a coordinate care and make people healthier even though it doesn't guarantee access. These things are extraordinarily complicated. Universal primary care is a simple idea. Okay, I have 29 seconds. There are few little things you might have to figure out. They're not insurmountable. How do you ask, you know, the ERISA question, questions about HSAs. There are wonderful experts who can help you through. I hope you will ask Herb Olson to testify to both of your committees. These things can be worked out. They're much simpler than ACOs, APMs and gold, silver, platinum and bronze. Thank you very much. Thank you. Our next on-deck witness is Travyn Laysham. All right, my name is Walter Carpenter. I am 62 years old and live in the city of Vonte Piculio, Vermont. Most everyone who knows me inside and outside this building knows that I am an activist for universal primary care. While I would like to see us take Act 48 off the shelf, shine it up and implement it like we should, I am fighting for UPC. I'd like to ask everyone in this well and for that matter, beyond it, a question. I apologize to the more veteran members of these committees for regurgitating a story that they may have heard before. How much are you worth? In other words, how much would you spend to save your life? Is it $20,000, $40,000, $80,000, $200,000? You have no insurance, you need the operation or you will certainly die in the excessively near future. In 21st century America, in 21st century Vermont, I had to make this choice. This dreadful decision could easily have been prevented with time and the access to a primary care physician. When the disease first manifested itself, I was working for a Vermont company and surprisingly even had it. Yet like so many companies, this company was owned by a parent and we had to subworn ourselves to it. The parent suddenly changed health insurers just as the symptoms were coming on and in one stroke my primary care physician was pushed into that void called out of network. Sure I could visit this doctor but only if I plunked down the hundreds of dollars of the uninsured rate. The new insurer lacked primary care providers in Vermont. The nearest one was probably in St. John'sbury about 60 miles away. I had to struggle to find a primary care physician and when I finally did, it was almost too late and I ultimately had a price on my life. I understand all the bizarre complications to UPC, difficulties that often seem more complex than the Apollo moon landings. We spend six billion and more annually for healthcare now. Some two million of that goes to just one healthcare CEO. We can do UPC. We did it as a first state in the Western world of the 18th century to abolish slavery. A sign out front here testifies to this state's courage in being the first to defy tradition norms regarding gay, lesbian marriage. We did it this week with marijuana. We can pass S53 H248. If we do, when we do, Nova Monter will ever again have to ultimately choose between medical debt forever or death for lack of a primary care physician. Thank you. On deck witness is Greg Sands. Hi, I'm Tenzin and I'm a critical care and cardiology nurse of the University of Vermont Medical Center. I see some of the sickest Vermonters come over to our floor and lay in the beds in front of me and I want to make sure you all know that primary care is life-saving too often when we have the very sickest of those patients. What they tell me is that they haven't seen a doctor in years, decades, ever. And when it does come down to this bill, I want to make sure all of you know that with primary care, it's life-saving and that just to, when it comes, I don't know if you sign a little box or push a yay or nay button that that button is the defibrillator button. It is your hands on that person's chest and it's watching that EKG tracing turn to a flat line. So go for it. Thanks. Thank you. Marjorie Powers on deck. I'll travel in my shunt for middle sex. I want to thank you for holding this important hearing in a time when working people can attend. Speaking this evening as a member of the Vermont Democratic Socialists of America, DSA, and our rapidly growing national organization is working with Senator Sanders and others to win improved Medicare for all. Not only Vermonters, but people across the country need you to get Vermont back on the track to guaranteeing healthcare as a human right. As a result of grassroots organizing in 2011, Vermont passed our universal healthcare law Act 48, which put us on the road to universal and unified publicly funded system. But it left undone the mechanism for financing, saying only that it must be equitable. Vermonters and people across the US were set back when Governor Shumlin, after multiple delays, announced that his financing plan was finally complete, but that the taxes were too high. By failing to fulfill his statutory obligation to send three financing proposals to the legislature, he not only short circuited Vermont's progress, he provided opponents of universal healthcare nationally the opportunity to claim that single payer had proved unworkable in Vermont. Debate would stop before it could even begin. The healthcare as a human right campaign offered a detailed plan for equitable healthcare financing supported by over 100 economists, which we attempted to get a public hearing for. Finally, we have a public hearing years later. Thank you. Our report concluded, quote, Vermont has the ability and obligation to implement a universal publicly financed healthcare system. The healthcare human right campaigns financing plan improves upon the governor's proposal with a more equitable solution for businesses contribution to the healthcare system, thus making payroll financing economically feasible. Our plan sets green mountain care on a solid financial footing and guarantees access to comprehensive healthcare for all Vermont residents. People will contribute based on their ability so that low and middle income people pay a smaller share of their income on healthcare than the wealth.