Alec Koumjian lives in Guilford. “Disclosure: My wife is a nurse-midwife in Brattleboro,” he writes.
GUILFORD-Vermont’s Legislature and governor recently appropriated $10 million in unexpected General Fund revenue for the University of Vermont’s proposed athletic and event center. The money became available because transfers from the state’s unclaimed-property program were higher than expected.
At the same time, the Birthing Center at Brattleboro Memorial Hospital and other essential rural hospital services are struggling to remain open.
The most practical source of help is not necessarily a new appropriation. In the current fiscal and political climate, proposals for millions of dollars in additional spending will be difficult to pass.
Meanwhile, Vermont has already identified and approved $10 million for a capital project. The Legislature should determine how much from this revenue source remains available and redirect it toward essential rural health care.
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The economics of medical care are increasingly shaped by forces outside the control of any one hospital or community.
Labor, medication, equipment, and regulatory costs continue to rise. Our fragmented health-insurance system also creates an extremely inefficient market. Hospitals must navigate multiple insurers, prices, billing systems, authorization requirements, and reimbursement rules. A substantial amount of money and staff time is spent administering that system rather than delivering care.
These pressures are especially damaging in rural communities.
There, maternity care and other essential services require trained staff, equipment, anesthesia, surgical support, and emergency capacity to be available around the clock, even when patient volumes are low.
Reimbursement often does not reflect the cost of maintaining that readiness. A service can be financially unsustainable under the existing system while remaining essential to the community.
Closing a rural service does not eliminate the need for it. It shifts patients to other hospitals and assumes those facilities will always have the staffing and capacity to accept them.
That assumption is not dependable.
Cheshire Medical Center in Keene, New Hampshire, and Baystate Franklin Medical Center in Greenfield, Massachusetts, have gone on diversion when staffing or capacity prevented them from accepting obstetric patients, and BMH has accepted patients when neighboring facilities could not.
Regional hospitals function as a network, supporting one another during periods of strain. Removing BMH’s Birthing Center would reduce the capacity and resilience of the entire regional system.
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The UVM project may be worthwhile, and I support investment in Vermont’s public university. But it remains dependent on a major private fundraising campaign. Act 144 anticipates approximately $89 million in new donations by 2029, in addition to the state’s contribution.
That $10 million will not complete that project. It could, however, provide a meaningful bridge for rural hospitals while Vermont works on the larger reforms needed to make essential services sustainable.
I have drafted proposed legislation that would direct the available portion of the UVM appropriation to a Rural and Community Hospital Essential Services Stabilization Fund. The program would not be limited to BMH, although preserving the Birthing Center should be an immediate priority.
These funds could support maternity care, emergency services, behavioral-health care, and other services whose loss would leave communities without realistic alternatives.
This should not be unrestricted assistance. Hospitals receiving funds should demonstrate urgent need, commit to maintaining the supported service, provide financial transparency, pursue available federal support, and present a credible plan for long-term sustainability.
Redirecting this appropriation would not solve the national healthcare financing problem or permanently resolve the challenges facing Vermont’s hospitals. It would preserve essential capacity while those harder problems are addressed.
I have asked members of the Windham County legislative delegation to consider this approach. I hope Gov. Phil Scott and lawmakers will do the same. The fact that the UVM appropriation has already been enacted should not prevent Vermont from reconsidering its priorities, particularly if much of the money remains unspent.
The choice is not simply between finding a new source of money and allowing rural services to disappear.
This Voices Viewpoint was submitted to The Commons.
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