RICHMOND, Vt. — On a heat autumn morning, Roger Brown walked via a grove of towering bushes 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 bushes’.
The price of Slopeside Syrup’s worker medical insurance premiums spiked 24% this yr. Subsequent yr it would 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 essentially 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 very best costs nationwide for particular person well being protection, and state studies present its suppliers and insurers are in monetary bother. 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 change into more and more frequent, based on state studies and interviews with residents and business officers.
Rising well being prices are an issue throughout the nation, however Vermont’s state of affairs surprises well being specialists 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 centered on growing the variety of individuals insured, which they anticipated would shore up hospital funds and make care extra obtainable 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 skilled 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 stay in rural areas, the place it’s troublesome to draw extra well being staff to handle shortages.
At the least a part of the associated fee spike may be attributed to sufferers crossing state traces for faster care in New York and Massachusetts. These visits may be dearer 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 instructed her in April that she wanted knee substitute 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 Heart she and her husband function as an inn and a spa. “My life is on maintain right here, and it’s laborious to make any plans,” she mentioned. “It’s horrible.”
Well being specialists say a few of the state’s well being system troubles are self-inflicted.
In contrast to most states, Vermont regulates hospital and insurance coverage costs via an impartial company, the Inexperienced Mountain Care Board. Till lately, the board usually permitted 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 manage about two-thirds of the state’s hospital market and allowed its fundamental facility, the College of Vermont Medical Heart in Burlington, to lift its costs till it ranked among the many nation’s most costly, she mentioned, citing information the board offered in September.
Hospital officers contend their costs are not any increased than business averages.
However for 2025, the board required the College of Vermont Medical Heart 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 laborious to recruit staff, whereas too few psychological well being suppliers, nursing houses, and long-term care providers 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 packages pay suppliers decrease charges than personal insurance coverage, which Eappen mentioned makes it troublesome to afford rising costs for medicine, medical gadgets, and labor.
Officers on the College of Vermont Medical Heart 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 massive house buildings to deal with new staff, at a backed worth for lower-income staff.
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 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, medical doctors face stress to discharge sufferers with out the best dwelling or group care setup, she mentioned. “We’ve got to go within the path of letting you go dwelling with out affected person providers and giving {that a} strive, as a result of in any other case the hospital goes to be full of individuals, and that features folks that don’t must be right here,” McNamara mentioned.
Trying to find options, the Inexperienced Mountain Care Board employed a guide who really helpful various adjustments, together with changing 4 rural hospitals into outpatient services, in a worst-case situation, and consolidating specialty providers 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 really helpful changing to an outpatient heart solely was North Nation Hospital in Newport, a village in Vermont’s least populated area, often called 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 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 lately dropped a number of specialty providers, together with pulmonology, neurology, urology, and orthopedics. It doesn’t have the money to improve affected person rooms to incorporate rest room doorways vast 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 individuals within the ER. “This place was once 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 popularity, he mentioned. “The price of well being care is a symptom of a bigger downside.”
About 30 miles south of Newport, Andy Kehler usually worries about the price of offering medical insurance to the 85 staff at Jasper Hill Farm, the cheesemaking enterprise he co-owns.
“It’s a problem yearly for us, and it seems like there isn’t a finish in sight,” he mentioned.
Jasper Hill pays half the price of its staff’ medical insurance premiums as a result of that’s all it may possibly afford, Kehler mentioned. Workers 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.