RICHMOND, Vt. — On a heat autumn morning, Roger Brown walked via a grove of towering timber whose sap fuels his maple syrup enterprise. He was checking for injury after latest flooding. However as of late, his employees’ well being worries him greater than his timber’.
The price of Slopeside Syrup’s worker medical insurance premiums spiked 24% this yr. Subsequent yr it is going to rise 14%.
The jumps imply much less cash to pay employees, and costly insurance coverage protection that doesn’t guarantee staff can get care, Brown mentioned. “Vermont is seen as probably the most progressive state, so how is well being care right here so screwed up?”
Vermont persistently ranks among the many healthiest states, and its unemployment and uninsured charges are among the many lowest. But Vermonters pay the best costs nationwide for particular person well being protection, and state experiences present its suppliers and insurers are in monetary bother. 9 of the state’s 14 hospitals are shedding cash, and the state’s largest insurer is struggling to stay solvent. Lengthy waits for care have turn into more and more frequent, in keeping with state experiences and interviews with residents and trade officers.
Rising well being prices are an issue throughout the nation, however Vermont’s scenario surprises well being consultants as a result of just about all its residents have insurance coverage and the state regulates care and protection costs.
For greater than 15 years, federal and state policymakers have targeted on growing the variety of individuals insured, which they anticipated would shore up hospital funds and make care extra accessible and inexpensive.
“Vermont’s struggles are a wake-up name that insurance coverage is just one piece of the puzzle to making sure entry to care,” mentioned Keith Mueller, a rural well being knowledgeable on the College of Iowa.
Regulators and consultants say the state’s small, growing older inhabitants of about 650,000 makes spreading insurance coverage danger troublesome. That demographic problem is compounded by geography, as many Vermonters reside in rural areas, the place it’s troublesome to draw extra well being employees to handle shortages.
At the least a part of the associated fee spike might be attributed to sufferers crossing state strains for faster care in New York and Massachusetts. These visits might be costlier for each insurers and sufferers due to lengthy ambulance rides and fees from out-of-network suppliers.
Sufferers who keep, like Lynne Drevik, face lengthy waits. Drevik mentioned her physician advised her in April that she wanted knee alternative surgical procedures — however the earliest appointment can be in January for one knee and the next April for the opposite.
Drevik, 59, mentioned it hurts to climb the steps within the Nineteenth-century farmhouse in Montgomery Middle she and her husband function as an inn and a spa. “My life is on maintain right here, and it’s onerous to make any plans,” she mentioned. “It’s horrible.”
Well being consultants say a few of the state’s well being system troubles are self-inflicted.
Not like most states, Vermont regulates hospital and insurance coverage costs via an impartial company, the Inexperienced Mountain Care Board. Till not too long ago, the board sometimes accredited no matter worth adjustments firms wished, mentioned Julie Wasserman, a well being guide in Vermont.
The board allowed one well being system — the College of Vermont Well being Community — to regulate about two-thirds of the state’s hospital market and allowed its major facility, the College of Vermont Medical Middle in Burlington, to lift its costs till it ranked among the many nation’s most costly, she mentioned, citing information the board introduced in September.
Hospital officers contend their costs are not any larger than trade averages.
However for 2025, the board required the College of Vermont Medical Middle to chop the costs it payments non-public insurers by 1%.
The nonprofit system says it’s navigating its personal challenges. Prime officers say a extreme lack of housing makes it onerous to recruit employees, whereas too few psychological well being suppliers, nursing properties, and long-term care companies typically create delays in discharging sufferers, including to prices.
Two-thirds of the system’s sufferers are coated by Medicare or Medicaid, mentioned CEO Sunny Eappen. Each authorities packages pay suppliers decrease charges than non-public insurance coverage, which Eappen mentioned makes it troublesome to afford rising costs for medication, medical units, and labor.
Officers on the College of Vermont Medical Middle level to a number of methods they’re attempting to adapt. They cited, for instance, $9 million the hospital system has contributed to the development of two giant residence buildings to accommodate new employees, at a backed worth for lower-income staff.
The hospital additionally has labored with group companions to open a psychological well being pressing care middle, offering an alternative choice to the emergency room.
Within the ER, curtains separate areas within the hallway the place sufferers can lie on beds or gurneys for hours ready for a room. The hospital additionally makes use of what was a storage closet as an overflow room to offer care.
“It’s good to get sufferers right into a hallway, because it’s higher than a chair,” mentioned Mariah McNamara, an ER physician and affiliate chief medical officer with the hospital.
For the about 250 days a yr when the hospital is full, docs face strain to discharge sufferers with out the perfect dwelling or group care setup, she mentioned. “We’ve got to go within the course of letting you go dwelling with out affected person companies and giving {that a} strive, as a result of in any other case the hospital goes to be full of individuals, and that features those that don’t have to be right here,” McNamara mentioned.
Trying to find options, the Inexperienced Mountain Care Board employed a guide who advisable quite a few adjustments, together with changing 4 rural hospitals into outpatient amenities, in a worst-case situation, and consolidating specialty companies at a number of others.
The guide, Bruce Hamory, mentioned in a name with reporters that his report gives a highway map for Vermont, the place “the well being care system is not any match for demographic, workforce, and housing challenges.”
However he cautioned that any repair would require sacrifice from everybody, together with sufferers, employers, and well being suppliers. “There isn’t any easy single coverage resolution,” he mentioned.
One place Hamory advisable changing to an outpatient middle solely was North Nation Hospital in Newport, a village in Vermont’s least populated area, often known as the Northeast Kingdom.
The 25-bed hospital has misplaced cash for years, partly due to an digital well being report system that has made it troublesome to invoice sufferers. However the hospital additionally has struggled to draw suppliers and make sufficient cash to pay them.
Officers mentioned they might struggle any plans to shut the hospital, which not too long ago dropped a number of specialty companies, together with pulmonology, neurology, urology, and orthopedics. It doesn’t have the money to improve affected person rooms to incorporate toilet doorways vast sufficient for wheelchairs.
On a latest morning, CEO Tom Frank walked the halls of his hospital. The ability was quiet, with simply 14 admitted sufferers and solely a few individuals within the ER. “This place was bustling,” he mentioned of the previous pulmonology clinic.
Frank mentioned the hospital breaks even treating Medicare sufferers, loses cash treating Medicaid sufferers, and makes cash from a dwindling variety of privately insured sufferers.
The state’s strict rules have earned it an antihousing, antibusiness status, he mentioned. “The price of well being care is a symptom of a bigger downside.”
About 30 miles south of Newport, Andy Kehler typically worries about the price of offering medical insurance to the 85 employees at Jasper Hill Farm, the cheesemaking enterprise he co-owns.
“It’s a difficulty yearly for us, and it appears to be like like there is no such thing as a finish in sight,” he mentioned.
Jasper Hill pays half the price of its employees’ medical insurance premiums as a result of that’s all it might afford, Kehler mentioned. Staff pay $1,700 a month for a household, with a $5,000 deductible.
“The protection we offer is insufficient for what you pay,” he mentioned.
