MONTPELIER – The debate over health care legislation known as S.190 may ultimately be remembered as one of the defining affordability fights of this legislative session. At issue was whether Vermont would finally take aggressive action to confront some of the highest health insurance premiums in America or continue down the same path that has steadily priced more Vermonters out of coverage.
S.190 accelerates the use of reference-based pricing for Vermont hospitals, an effort aimed at lowering the amount commercial insurers pay for hospital services. Supporters argued that without meaningful intervention, premiums would continue spiraling upward for working families, small businesses, municipalities, and school districts already under crushing financial strain.
The bill proved highly contentious, even though it finally passed the House.
Opponents raised legitimate concerns about the financial stability of Vermont hospitals, particularly rural facilities already operating under enormous pressure from workforce shortages, inflation, and declining federal support. Others argued against the bill because it would not immediately help every Vermonter equally.
Yet testimony before lawmakers indicated that approximately 100,000 Vermonters would receive the greatest premium relief under the proposal. In a state the size of Vermont, this is significant.
What became frustrating to many supporters was the argument that because the bill could not solve the entire affordability crisis for everyone at once, it should not move forward at all.
By that logic, because there were not enough lifeboats to save everyone on the Titanic, you would not help anyone.
That is not governing. That is paralysis.
The reality is, Vermont’s health care affordability crisis is no longer theoretical. It is here now.
If reference-based pricing rules had been in effect last year, regulators could have increased commercial reimbursement levels at the Copley Hospital birthing center with far greater precision, potentially eliminating many of the financial arguments used to justify cutting those services. Regulatory tools are urgently needed that allow Vermont to stabilize critical health care access while also controlling costs.
An estimated 5,000 Vermonters have already lost health insurance coverage following the expiration of enhanced federal premium assistance programs. Thousands more have responded to rising costs by reducing benefits, accepting higher deductibles, or purchasing less comprehensive coverage.
And when people lose coverage or delay care, the costs do not disappear. Hospitals still provide emergency treatment. Uncompensated care still exists. Those costs are then shifted back onto the commercial insurance market, driving premiums even higher for everyone else.
That vicious cycle is one reason Vermont’s commercial insurance costs have become increasingly unsustainable.
I explained my vote as follows:
“It has been said before: if you always do what you always did, you will always get what you always got. I am tired of getting some of the highest health insurance premiums in the country. I stand proudly fighting for greater affordability.”
That sentiment captured the mood of many legislators who voted yes.
No one claimed S.190 was a perfect bill. No one claimed it would instantly fix Vermont’s health care system. But supporters argued that continuing to do nothing while premiums explode was itself a dangerous decision.
In many ways, this may prove to be the single largest affordability measure passed by the Legislature this year.
Health insurance costs ripple through nearly every aspect of Vermont life: family budgets, business competitiveness, municipal finances, school property taxes and workforce recruitment.
For years, Vermonters have demanded action on affordability. S.190 represents an acknowledgment that incremental rhetoric without structural change is no longer enough.
The larger challenge now will be balancing affordability with the financial realities facing Vermont hospitals. That balancing act will require continued oversight, flexibility, and likely future adjustments.
But one thing has become increasingly clear: Vermont cannot preserve meaningful access to health care if ordinary Vermonters can no longer afford to buy health insurance in the first place.
