ClearChoice executive calls Vermont urgent care measure 'unconstitutional'


A private company with plans to open urgent care centers across Vermont this summer says a House-passed amendment unfairly targets its business and is unconstitutional.

The amendment to a larger health care reform package, which has not yet passed the Legislature, would prohibit non-emergency walk-in clinics from discriminating against patients "on the basis of insurance status or type of health coverage."

An executive for ClearChoiceMD, which intends to open five urgent care centers in the state over the coming months, said such a provision is unconstitutional because Vermont's regulatory framework regards urgent care centers as physician offices, however the amendment doesn't place a mandate to care for the uninsured on all physician offices -- just urgent care centers.

"There's no difference between us and a family practice or dental office," ClearChoice President Michael Porembski said. "I can't just walk into a dentist's office and demand a crown if I can't afford to pay for it."

Vermont hospitals, which are also planning to open urgent care centers, are required to treat the uninsured as part of their nonprofit mission and mandate, Porembski said, but they also have access to public payment models that compensate based on the proportion of uninsured and subsidized patients they serve.

Rep. Mike Fisher, D-Lincoln, who co-sponsored the amendment with Rep. Tom Koch, R-Barre Town, would not comment on the constitutionality of his proposal, except to say that he had asked legislative counsel to help craft the amendment and was not aware of any legal issues with the proposal.

State regulators recently issued a decision that the clinics ClearChoice intends to open do not need to go through an additional oversight process because they're considered physicians' offices.

ClearChoice has said its clinics will accept Medicaid and will provide a discounted fee structure for the uninsured, but if somebody doesn't have the ability to pay for their services the company has said it will stabilize their condition and transfer the patient to another location, likely a hospital-run urgent care center or an emergency room.

Porembski said Fisher's amendment would have a "tremendous" negative impact on ClearChoice's business model.

"The state has no right and no authority to reach into our pockets," he added.

The provision is contained in the House-passed version of S.252. The bill was not on the Senate's action calendar Monday, but Senate Pro Tem John Campbell said it is likely to be sent to a conference committee this week, where the differences with the Senate version will be reconciled.


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