A Vermont Senate committee has advanced a pair of health care bills that would build on incremental reforms aimed at controlling costs and improving access to care without making sweeping changes.
Instead, the measures target primary care and hospital cost containment by improving access, cost transparency, and alignment between insurers and providers.
The legislation, S.190 and S.197, passed unanimously out of the five-member Senate Health and Welfare Committee last Friday, the deadline for most bills to advance to stay viable. Neither has yet been voted on by the full Senate or sent to the House.
Sen. Ginny Lyons (D-Chittenden-Southeast), who chairs the committee, celebrated the milestone at a press conference in the Statehouse on Tuesday. Lyons and health care advocates who spoke framed the bills as practical measures to address Vermont’s affordability crisis.
“If we look at the cost of premiums that folks pay in Vermont, they’re three or four times higher than what you would pay in other states. ” Lyons said. “Those premiums are really causing people to sacrifice their lives in many ways,” she added, describing how high medical costs can force people to delay vacations and major purchases.
S.190 focuses primarily on hospital pricing and oversight. The bill would further expand the authority of the Green Mountain Care Board and move the state toward reference-based pricing, a system that ties what insurers pay hospitals for services to a benchmark, typically Medicare reimbursement rates. If passed, the bill would limit what hospitals can charge people covered by plans purchased through the state’s insurance marketplace.
The legislation also calls for a committee to explore avenues for providing health benefits to all public-sector employees in Vermont with the goal of creating a larger insurance pool to stabilize costs over time.
Mike Fisher, Vermont’s health care advocate, applauded that bill’s potential to cap costs in the small group market, which covers employers with fewer than 100 employees as well as municipalities. By capping prices in that sector, Fisher said, the legislature is taking an important step toward making coverage more affordable.
The other bill, S.197, would shift how Vermont pays for primary care by moving away from fee-for-service and instead providing a set per-patient payment to providers. The bill would also draw more health insurers to participate in the state’s Blueprint for Health, designed to facilitate care between patients, primary care providers and community support.
The bills’ changes may be incremental, but Jessa Barnard, executive director of the Vermont Medical Society, says they matter, especially in a state already “the envy of many others” for its coordinated care system.
“Some of the really big ideas are actually difficult, if not impossible, to actually put in place,” Barnard said, “so these are steps that are both pretty impressive steps forward and accomplishable.”
Sen. Kesha Ram Hinsdale (D-Chittenden-Southeast) praised Lyons during Tuesday’s press conference for both her efforts to develop the bills and securing unanimous bipartisan support in her committee.
“This health care package makes real change — it really, truly drives costs down,” Ram Hinsdale said.
Devon Green, vice president of government relations for the Vermont Association of Hospitals and Health Systems, said the association supports the proposed changes to primary care and has worked to ensure that hospital pricing reforms are sustainable. In recent years, Vermont hospitals have navigated efforts to make them more affordable, including hospital transformation overseen by the Agency of Human Services and caps on prescription drug prices passed by the legislature last year.
“We want to ensure we’re all looking at these efforts together as one coordinated effort, as opposed to doing things in isolation that could have a negative consequence on our finances, or access or quality of care,” Green said on Wednesday.
At Tuesday’s press conference, Rachel Van Vliet, a special education teacher at Barre Town Middle & Elementary School and president of the local teachers union, highlighted the connection between health care costs, school budgets and property taxes. Over the past five years, property taxes across Vermont have increased roughly 40 percent, fueled in large part by rising school budgets. Rising insurance premiums for school employees are a major driver of those increases, Van Vliet noted.
The pressures extend beyond schools. Donna Bailey, who runs a nonprofit parent-child center in Addison County, said her organization spends more than $270,000 annually on health coverage for half of her 34 employees, a burden she called “astronomical” for a small business.
While the bills have drawn support from advocates, providers and labor groups, it’s still early in the legislative process. The House Health Care Committee has developed similar proposals, and lawmakers will need to reconcile significant differences between the chambers’ versions in the weeks ahead.
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