Dozens of Vermonters we heard from this election season brought up concerns around the high costs of medication and insurance rate increases, along with access to medical providers and mental health treatment, Medicaid coverage, and compensation for EMS workers.
Many also called for universal primary care and a single-payer health care system.
We assembled a guide for understanding how elected officials can — and can’t — move the needle on health care issues in the state.
Jump to a section:
- The basics
- Changes the Legislature and governor have made recently
- What state officials matter most on the issue
- What state officials can do about it
- What the candidates are saying this year
Let's walk through it together. This guide tells you how voting can impact health care in Vermont. Or explore another top issue:
The basics
Health care costs in Vermont have risen dramatically in recent years, impacting businesses big and small, school budgets and resulting property taxes. Many commercial insurance plans have seen double-digit rate increases for years — some government-regulated insurance plans have more than doubled since 2014. That’s a big difference from much of the rest of the country.
One reason insurance rates are going up so much in Vermont is because of rising hospital costs. Vermont’s hospitals are some of the most expensive in the country. Yet, many are operating at a loss, and a recent report commissioned by the state says those losses are expected to worsen in the coming years.
Some good news: Access to care in Vermont is better than in many other states — some 95% of Vermonters have health care coverage and almost 90% have a health care provider, according to a Department of Health report released this year.
Still, many Vermonters are underinsured, and about 12% are saddled with medical debt. Long wait times for primary and specialty care delay necessary care. The state lacks capacity in home health care and long-term care facilities, and the reimbursement model for the state’s emergency medical system often doesn’t cover the cost of delivering services.
Many of these problems are exacerbated by staffing shortages and demographic trends in the state.
Changes the Legislature and governor have made recently
Medicaid: Budgets approved by Vermont lawmakers in recent years have included increases in Medicaid reimbursement rates for certain types of health care providers, such as community-based residential care facilities and dentists.
The Legislature has also expanded access to government-subsidized health insurance for groups that weren’t previously eligible, including the children of parents whose citizenship status prevents them from enrolling in Medicaid.
Prior authorization: The new law, enacted earlier this year, attempts to expedite access to health care services by prohibiting insurance companies from requiring primary care providers to seek permission before ordering tests and health procedures. It takes effect Jan. 1, 2025.
Medicare Savings Program: An estimated 12,000 low-income seniors will see the government cover their Medicare Part B premiums after lawmakers increased income-eligibility thresholds for the Medicare Savings Program.
Pharmacy benefit managers: A 2024 law requires pharmacy benefit managers to get a license from the Department of Financial Regulation, and it prohibits them from charging an insurer more for a drug than they pay for it.
What state officials matter most on the issue
Green Mountain Care Board: The GMCB is a five-person panel that has enormous power to establish pay schedules for providers, control hospital budgets, and approve or deny rate increases from some private insurance companies — about a quarter of the commercial insurance market. The board also oversees requests for investments in large health care infrastructure, like new buildings or expensive equipment.
Members are appointed by the governor for 6-year terms, and subject to confirmation by the Senate.
Agency of Human Services: This agency is part of the executive branch. Agency leaders are appointed by the governor and confirmed by the Senate. It’s made up of several departments, including the Department of Vermont Health Access (DVHA), the Department of Health and the Department of Mental Health.
Attorney general: This office plays a relatively small role in regulating the health care system. They are responsible for investigating Medicaid fraud and medical malpractice, and defending the state if it’s sued.
The Legislature: Lawmakers, along with the governor, allocate the state budget — they decide what to prioritize under finite resources. Lawmakers also provide oversight of the health care system and set the rules and standards for regulators to enforce.
What state officials can do about health care in Vermont
Vast portions of the health care sector in Vermont — such as Medicare and large, self-insured companies, for instance — operate largely outside the purview of the governor and the Legislature. And the Legislature has relegated much of its authority over health care providers to the Green Mountain Care Board.
But the legislative and executive branches have the power to make potentially consequential decisions related to one of the largest payers in the state’s health care system, which is Medicaid.
Lawmakers and the governor can enact laws that determine who’s eligible for the government-subsidized insurance program, and they can also make adjustments to the amount of money providers receive from Medicaid for providing health care services. However, changes to Medicaid policy are contingent on federal approval, which is much more likely if there is precedent in other states.
Single-payer health care advocates continue to push lawmakers for legislation that would replace private insurance premiums with a single state-run insurer. Top leaders in the legislative and executive branches have shown no inclination to pursue that path, which would require significant waivers from the federal government.
What the candidates are saying this year
“With the high cost of living in Vermont, I don’t see how there’s any way for us to take on a single-payer on our own.” - John Rodgers, Republican candidate for lieutenant governor
“How do we make Vermont more affordable? Honestly, I think about healthcare. So, expanding Medicaid, so that folks with low to mid income are able to be covered.” - Esther Charlestin, Democratic candidate for governor
“I would support revisiting creating a single-payer health care system for Vermont. We gave up that hard work far too early in my opinion.” - Alison Clarkson, Democratic Candidate for Vermont Senate, Windsor district
“I personally think expanding access to Medicaid is the most realistic strategy given what other challenges face us in Vermont.” - Jill Krowinski, Democratic candidate for Vermont House, Chittenden-16
“Expanding reforms to prior authorization legislation in the previous biennium to include prescription drugs would be another good step toward reducing costs.” - William “Will” Greer, Democratic candidate for Vermont House, Bennington-2
“Get rid of the Green Mountain Care Board and the rest of the wasteful inept system. ... We need to lower costs, develop better synergy, eliminate bureaucracy, and reduce the salaries of hospital admins to less than $800K.” - Eugene Bifano, Common Sense candidate for Vermont House, Washington-2
“As a state, we should be ensuring everyone has access to nutritious food. State food stamps should be applicable to whole foods, not processed foods. We need health care systems that lower the prevalence and cost of chronic illnesses.” - Renee McGuinness, Republican candidate for Vermont House, Addison-4
Find more candidate responses to questions about housing, taxes and affordability, climate and environment, health care and education in Vermont Public's candidate guide and debates.
How to vote in the general election
Eligible voters can register anytime up to and on Election Day, Nov. 5.
You can register online, in-person at your town clerk’s office, or on Election Day at your polling place.
Voting
If you received a ballot in the mail, you can return it by mail or take it to your town’s dropbox.
You can also vote early, in-person at your town clerk’s office or on Election Day at your polling place.
If you get a mail-in ballot but plan to vote in person, bring the ballot with you to your polling place.
Learn more
Find your registration status, ballot information, polling place info and more at your My Voter Page.
Get more information about the voting process in Vermont Public’s general election guide, and learn about who’s running in our candidate questionnaire.
This story is part of Vermont Public’s Citizens Agenda approach to election coverage. We’re asking a simple question: What do you want the candidates to be discussing as they compete for your votes? Front Porch Forum is our lead outreach partner for this project.
Have questions, comments, or tips? Send us a message.
