In Bernie’s State, Can This Republican Lead on Health Care?
WHY YOU SHOULD CARE
Because conservatism isn’t always where you expect to find it.
When Phil Scott barrels his No. 14 stock car around Thunder Road outside his hometown of Barre, Vermont, it’s easy to assume the 59-year-old has a need for speed. After all, he’s raced motorcycles and snowmobiles everywhere from America’s Midwest to Ontario, Canada, amassing dozens of wins across a three-decade career.
Ask Scott, though, and he’ll dig into the psychology, not the adrenaline rush: “There are some good drivers, and some not so good; some who are very emotional, some who are more patient than others. And then there are some who are driving over their head.” Soft-spoken and silver-haired, Scott couldn’t be more at home speaking from his crew’s garage: “It’s all about strategy. And trying to not over-drive the car.”
Good advice for the racetrack, and a fitting allegory for Scott. In November, the driver won another race — this one to become the Republican governor of Vermont, in the backyard of Bernie, no less. Having served as lieutenant governor and a state senator, Scott advertised himself as a cautious driver, replacing Pete Shumlin, the Democrat governor who promised the moon with the nation’s first single-payer health care system and then failed to deliver. Scott’s campaign message was simple: Elect me, and I will make Vermont more affordable. Facing a revenue downgrade and a deficit upon taking office in January, his priorities have remained similarly mild-mannered while trying to reverse what he called the state’s “6-3-1” problem: six fewer workers, three fewer students and nearly one baby born into opioid-related addiction each day. “We had to live within our means,” he says, while trying to steady the wheel.
His strategy has panned out politically. Fiscal responsibility sells in Vermont, with money-minded Republicans and independents launching Scott into office. “Economic issues are always the No. 1 concern of Vermonters,” wrote local columnist and radio host Mike Smith. This summer, Scott passed the budget without levying additional taxes or fees, but the Green Mountain State still has other economic concerns. Property tax rates are rising — in Vermont, taxes are tied to per-pupil spending in the schools, and with 20,000 fewer students than just 15 years ago, tax bills have gone up. Plus, an aging workforce is putting stress on the tax base, a problem throughout New England as the region tries to attract talent while manufacturing jobs continue to flock south.
Vermont faces, in microcosm, the same struggle many states face, but with a key twist — a state assembly led by Democrats but as a whole more moderate than most. “It’s not like Washington, D.C. Here, very seldom do we take sides and bicker,” says state senator Dick Mazza, a Democrat who has supported Scott’s rise at every political rung. In Vermont, Scott has successfully campaigned on management skills and fiscal responsibility, while tacking moderate on abortion and gay marriage. And Democrats in D.C. applaud his willingness to stand against Trump — he was one of a handful of Republican governors to publicly denounce the president’s DACA stance and the AHCA Obamacare repeal bill this summer. “He’s just a guy who plunges in,” says Peter Welch, representative for Vermont’s at-large U.S. congressional district. “Whatever the job is that needs to be done, that’s the job he wants to do.”
That was never more true than with Scott’s Everyday Jobs Initiative — think Dirty Jobs and Undercover Boss gone political. As lieutenant governor, Scott worked 35 different professions, from emergency rooms to distilleries, alongside bakers and veterinarians. “I was working side by side with those people, who were working two or three jobs trying to make ends meet,” he says from his office in Montpelier. “I thought to myself: Why is it we struggle so much here?” And that’s when he concluded: “We have an affordability problem.”
And he set to work, part of a hands-on approach his mother, Marian DuBois, says he’s shown since he was a woodshop student, racing homemade buggies down Onward Street in Barre. His father, a double-amputee World War II veteran, died when Scott was 11, and the middle child of three boys stepped up. “He took on the responsibiliy very young,” DuBois says.
As a 20-something with an industrial education degree from the University of Vermont, Scott started a motorcycle business. When he tried to expand it, the expansion effort failed after a year of red tape. Later, as a co-owner of DuBois Construction with his cousin, he encountered similar regulatory frustrations. It prompted his entrance into Republican politics, and he became a state senator in 2000.
Scott has professed a more cautious approach to politics than his racing days would suggest, yet his initiatives are blazing a trail all the same. His administration has championed a $35 million housing bond to grow low- and middle-income housing. The hub-and-spoke opioid addiction treatment model, which Vermont has had since 2000, was expanded by Scott and has helped eliminate waiting lists that numbered in the hundreds in some cities.
By far the most striking effort is an “all-payer health care” pilot program. The feds have given Vermont a waiver to experiment with Medicare, Medicaid and commercial clients. Participating providers will be paid a per member-per month renumeration. Proponents say it should lower costs and encourage hospitals to be proactive about patient health and wellness, shifting the focus from treatment to prevention. What’s more, the plan aims to have 70 percent of insured residents covered by an accountable care organization (ACO) by 2022. While single-payer hones in on how to collect health care money, this tackles how to actually lower the cost of goods and services. “Here in Vermont, we’re small. It allows us to be nimble. You can test the theory here,” says Al Gobeille, secretary of the Vermont Agency of Human Services.
If the pilot program succeeds, health care could supplant Ben & Jerry’s as the state’s most important export. It would also launch Scott to another political stratosphere: remember Mitt Romney, another blue-state Republican governor who hung his hat on health care. Of course, Scott will have to prove Vermont can manage the initiative. While the state recently won a SCAN Foundation Pacesetter Prize for Affordability and Access in elder care, it bungled the rollout of Vermont Health Connect, the state-based marketplace designed to deliver the Affordable Care Act to recipients across the state. The new plan was hashed out while Scott was lieutenant governor, and he is now charged with leading its launch for the benefit of all Vermonters. “His point is, ‘I want to make it more affordable, I want to grow the economy and take care of the most vulnerable,’” says Gobeille, before adding, “You’re not going to do that without innovation.”
If you find it surprising that a little-known state governor could play an outsize role in the nation’s roiling health care debate, you’re not alone. When we meet in his Montpelier office, Scott is still chuckling over a Twitter exchange from the day before:
[Remembers Vermont has a Republican governor]
— Burgess Everett (@burgessev) September 19, 2017
[Googles the name of Vermont's Republican governor] https://t.co/08gU5eYu19
— Byron Tau (@ByronTau) September 19, 2017
[Is Vermont's Republican Governor] https://t.co/n3xuzrvUQX
— Governor Phil Scott (@GovPhilScott) September 19, 2017
The online exchange with Washington, D.C., journalists pokes fun at Scott’s anonymity — and he’s fine with that. “We like to lighten things up a bit. Twitter has become so divisive in some ways,” he says.
Less lighthearted is the criticism Scott has faced from some for not commiting longterm funds to the cleanup of Lake Champlain, Vermont’s largest water source. Right now, he’s agreed to $56 million annually the next two years, at the recommendation of the state treasurer. But before committing for the full two-decade cleanup, he’s suggested the state should study ”existing resources, financial tools and potential organically-generated revenue,” in lieu of raising taxes, his spokesperson says. He also took flak from teacher unions after suggesting a shift of school employee health care negotiations to the state level – currently between districts and employee unions – which he said would make agreements more uniform, and could result in cost cuts for teachers, plus $26 million in savings for taxpayers. Regardless, whether he can appease his critics and win re-election in 2018 will largely rely on his ability to deliver on the one concern that dwarfs all others: affordability. “For Scott, the reality is this,” Smith explains, “when you live by the economic message, you can be politically slain by it.”
Scott insists he’s willing to take that gambit — but he’s going to do it gracefully. That’s his way, he says. And you better believe he’s willing to invoke that mythology as a metaphor for his politics: “There are some racers that will drive right through you to move up a position. But I don’t rough somebody up to get by them. I pass them clean.”