RICHMOND, Vt. — On a heat autumn morning, Roger Brown walked by way of a grove of towering bushes whose sap fuels his maple syrup enterprise. He was checking for harm after latest flooding. However lately, his employees’ well being worries him greater than his bushes’.
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 workers can get care, Brown mentioned. “Vermont is seen as the most progressive state, so how is health care 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 hassle. 9 of the state’s 14 hospitals are dropping cash, and the state’s largest insurer is struggling to stay solvent. Lengthy waits for care have turn out to be more and more frequent, in response to 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 nearly 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 rising the variety of folks insured, which they anticipated would shore up hospital funds and make care extra obtainable and inexpensive.
“Vermont’s struggles are a wake-up call that insurance is only one piece of the puzzle to ensuring access to care,” mentioned Keith Mueller, a rural well being knowledgeable on the College of Iowa.
Regulators and consultants say the state’s small, ageing inhabitants of about 650,000 makes spreading insurance coverage threat 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.
A minimum of a part of the price spike will be attributed to sufferers crossing state strains for faster care in New York and Massachusetts. These visits will be costlier for each insurers and sufferers due to lengthy ambulance rides and prices 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 could 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 hold here, and it’s hard to make any plans,” she mentioned. “It’s terrible.”
Well being consultants say among the state’s well being system troubles are self-inflicted.
In contrast to most states, Vermont regulates hospital and insurance coverage costs by way of an impartial company, the Inexperienced Mountain Care Board. Till not too long ago, the board sometimes permitted no matter worth modifications firms needed, mentioned Julie Wasserman, a well being advisor 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 boost its costs till it ranked among the many nation’s costliest, she mentioned, citing information the board introduced in September.
Hospital officers contend their costs aren’t any increased than trade averages.
However for 2025, the board required the College of Vermont Medical Middle to chop the costs it payments personal insurers by 1%.
The nonprofit system says it’s navigating its personal challenges. Prime officers say a extreme lack of housing makes it exhausting to recruit employees, whereas too few psychological well being suppliers, nursing houses, 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 applications pay suppliers decrease charges than personal insurance coverage, which Eappen mentioned makes it troublesome to afford rising costs for medicine, medical units, and labor.
Officers on the College of Vermont Medical Middle level to a number of methods they’re making an attempt to adapt. They cited, for instance, $9 million the hospital system has contributed to the development of two massive house buildings to accommodate new employees, at a sponsored worth for lower-income workers.
The hospital additionally has labored with group companions to open a psychological well being pressing care heart, 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 supply care.
“It’s good to get patients into a hallway, as it’s better 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, medical doctors face strain to discharge sufferers with out the best dwelling or group care setup, she mentioned. “We have to go in the direction of letting you go home without patient services and giving that a try, because otherwise the hospital is going to be full of people, and that includes people that don’t need to be here,” McNamara mentioned.
Looking for options, the Inexperienced Mountain Care Board employed a advisor who advisable quite a few modifications, together with changing 4 rural hospitals into outpatient amenities, in a worst-case situation, and consolidating specialty companies at a number of others.
The advisor, Bruce Hamory, mentioned in a name with reporters that his report offers a street map for Vermont, the place “the health care system is no 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 is no simple single policy solution,” he mentioned.
One place Hamory advisable changing to an outpatient heart solely was North Nation Hospital in Newport, a village in Vermont’s least populated area, referred to as the Northeast Kingdom.
The 25-bed hospital has misplaced cash for years, partly due to an digital well being document 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 combat 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 broad sufficient for wheelchairs.
On a latest morning, CEO Tom Frank walked the halls of his hospital. The power was quiet, with simply 14 admitted sufferers and solely a few folks within the ER. “This place used to be 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 laws have earned it an antihousing, antibusiness popularity, he mentioned. “The cost of health care is a symptom of a larger problem.”
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 an issue every year for us, and it looks like there is no end in sight,” he mentioned.
Jasper Hill pays half the price of its employees’ medical insurance premiums as a result of that’s all it could actually afford, Kehler mentioned. Staff pay $1,700 a month for a household, with a $5,000 deductible.
“The coverage we provide is inadequate for what you pay,” he mentioned.
