RICHMOND, Vt. — On a heat autumn morning, Roger Brown walked by a grove of towering timber whose sap fuels his maple syrup enterprise. He was checking for injury after latest flooding. However today, his staff’ well being worries him greater than his timber’.
The price of Slopeside Syrup’s worker medical health insurance premiums spiked 24% this yr. Subsequent yr it should rise 14%.
The jumps imply much less cash to pay staff, 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 constantly ranks among the many healthiest states, and its unemployment and uninsured charges are among the many lowest. But Vermonters pay the highest prices nationwide for particular person well being protection, and state stories present its suppliers and insurers are in monetary hassle. 9 of the state’s 14 hospitals are losing money, and the state’s largest insurer is struggling to stay solvent. Long waits for care have develop into more and more widespread, based on state stories and interviews with residents and business officers.
Rising well being prices are an issue throughout the nation, however Vermont’s scenario surprises well being specialists 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 centered on growing the variety of folks insured, which they anticipated would shore up hospital funds and make care extra accessible and reasonably priced.
“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, getting older inhabitants of about 650,000 makes spreading insurance coverage danger tough. That demographic problem is compounded by geography, as many Vermonters reside in rural areas, the place it’s tough to draw extra well being staff to deal with shortages.
At the least a part of the associated fee spike might be attributed to sufferers crossing state traces for faster care in New York and Massachusetts. These visits might be costlier for each insurers and sufferers due to lengthy ambulance rides and costs 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 exhausting to make any plans,” she mentioned. “It’s horrible.”
Well being specialists 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 an impartial company, the Inexperienced Mountain Care Board. Till not too long ago, the board usually accepted no matter value adjustments corporations wished, mentioned Julie Wasserman, a well being advisor in Vermont.
The board allowed one well being system — the College of Vermont Well being Community — to manage about two-thirds of the state’s hospital market and allowed its most important facility, the College of Vermont Medical Middle in Burlington, to boost its costs till it ranked among the many nation’s most costly, she mentioned, citing knowledge the board introduced in September.
Hospital officers contend their costs aren’t any larger than business 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 staff, whereas too few psychological well being suppliers, nursing properties, and long-term care companies usually create delays in discharging sufferers, including to prices.
Two-thirds of the system’s sufferers are lined by Medicare or Medicaid, mentioned CEO Sunny Eappen. Each authorities applications pay suppliers decrease charges than personal insurance coverage, which Eappen mentioned makes it tough to afford rising costs for medication, medical gadgets, 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 giant house buildings to deal with new staff, at a backed value for lower-income staff.
The hospital additionally has labored with group companions to open a psychological well being pressing care middle, offering a substitute for 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 now have 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 people who don’t should be right here,” McNamara mentioned.
Looking for options, the Inexperienced Mountain Care Board employed a advisor who really helpful a variety of adjustments, together with changing 4 rural hospitals into outpatient amenities, in a worst-case state of affairs, and consolidating specialty companies at a number of others.
The advisor, Bruce Hamory, mentioned in a name with reporters that his report gives a street map for Vermont, the place “the well being care system isn’t 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 a easy single coverage resolution,” he mentioned.
One place Hamory really helpful 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 file system that has made it tough 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 huge 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 folks 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 repute, he mentioned. “The price of well being care is a symptom of a bigger drawback.”
About 30 miles south of Newport, Andy Kehler usually worries about the price of offering medical health insurance to the 85 staff at Jasper Hill Farm, the cheesemaking enterprise he co-owns.
“It’s a difficulty yearly for us, and it seems like there is no such thing as a finish in sight,” he mentioned.
Jasper Hill pays half the price of its staff’ medical health insurance premiums as a result of that’s all it may possibly 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.
