Health Care - 5/2/26

Happy Green Up Day,

Many House committees are in a lull while we wait for the Senate to finish work on their Education and Yield (setting property tax rates) Bills. These two, along with the budget, will all get negotiated in conference committees at the end of the session, and they are all intertwined. The Governor has threatened repeatedly to veto the budget if the legislature does not pass an education bill that he wants. Stay tuned for all the end of session developments in the coming weeks. We are scheduled to end the session May 15 - that is unlikely to happen. 

Demographics

There is a background reality that underlies and exacerbates many of the challenges we face as a state - demographics. There is a good article in Seven Days this week on Vermont’s lowest in the country birth rate. Did you know that, “The actual number of children born in the Green Mountain State is smaller today than before the Civil War, when Vermont had fewer than half as many residents it does now.” We are old and getting older quickly - this reality drives our education, health care and taxation woes. And it is particularly hard for government to address.

Health Care

We have not discussed health care much this session. It is, in my opinion, the biggest near term threat to Vermonters’ well being. Our rural hospital ecosystem is very fragile. We are likely to lose some hospitals in the next few years. Springfield Hospital has less than 30 days cash on hand - a very low level of this key metric. The Green Mountain Care Board is working hard to drive costs out of the system, but sometimes this is at odds with the ability of hospitals to adapt and survive. So much of health care policy revolves around Medicare and Medicaid that the levers for the legislature to pull are limited. Last year we passed a bill to change the pricing models of hospitals (reference based pricing) which will go into effect next year. This is what the legislature is working on now…

Increasing access to primary health care-

At its core, S197 asks a fundamental question: how do we ensure Vermont invests enough in primary care to make it accessible, sustainable, and effective? Primary care providers manage chronic conditions, coordinate specialty services, and help patients stay healthy before problems escalate into emergencies. Yet Vermont continues to face provider shortages, growing administrative burdens, and financial pressures on primary care practices. 

We are exploring how additional resources could be directed toward primary care so providers are compensated at levels that allow them to deliver comprehensive, patient-centered care. The working theory behind S.197 is that stronger investment in primary care will ultimately reduce overall health care costs by preventing complex medical conditions and reducing reliance on emergency rooms for routine or chronic care.

Hospital Service Line Decisions -

S.189  addresses how decisions are made when hospitals consider reducing or eliminating specific service lines.  Recent hospital transformation discussions have highlighted the need for transparency and meaningful public engagement when communities face potential loss of services such as maternity care, emergency services, or specialty programs.

There is broad agreement that a public process must be part of any decision affecting access to essential health care.  A central question under discussion is which state entity should hold final decision-making authority.

Health Care System Transformation and Oversight -

S.190 is intended to strengthen coordination, accountability, and long-term planning within Vermont’s health care system. It reflects growing recognition that Vermont’s current system — while built around strong institutions — often operates through fragmented programs, funding streams, and regulatory structures. The bill seeks to better align state agencies, regulators, and health care providers around shared statewide goals.  The legislation builds upon existing transformation work underway through the Agency of Human Services and other partners, with the goal of moving Vermont toward a more affordable and sustainable health care delivery system. 

As Vermont continues to face rising costs, workforce shortages, and demographic pressures, we are increasingly focused on aligning policies across agencies, so reforms reinforce one another instead of operating in isolation.