This commentary is by Ethan Parke of Montpelier, a board member of Vermont Health Care for All.
Don’t tell me that Vermont is addressing the affordability of health care. It’s not.
According to the Kaiser Family Foundation’s table of average marketplace premiums by metal tier, Vermont is by far the most expensive state in which to buy insurance through the Affordable Care Act.
In 2024, Vermonters pay an average of $948 a month for the lowest-cost silver plan, compared with just $324 a month in neighboring New Hampshire, for the exact same coverage. The national average is $468.
The Legislature is either unaware of this statistic, or doesn’t care.
The largest driver of insurance rates is hospital care. So, does Vermont have more hospital beds per capita than other states? Do we need to close hospitals?
According to Kaiser, Vermont ranked 39th out of 51 in per capita community hospital beds, at 2.03 per 1,000 people, compared with the District of Columbia with 5.01 beds and South Dakota with 4.61 beds per capita.
The national average was 2.35.
If it’s not the number of beds, then perhaps Vermonters are much older than people in other states?
An aging population is often blamed for high health care costs. We are indeed near the top in terms of median age, but we are not as old as New Hampshire or Maine. I’ve already pointed out that New Hampshire’s Affordable Care Act premiums are about a third of Vermont’s, going by lowest-cost silver plan. Maine’s are about 54% of ours.
There has to be another explanation for Vermont’s exorbitant health insurance costs.
Is it payer mix? Does Vermont have a larger percentage of people on Medicaid than other states, causing a cost shift onto commercial insurance? No.
Vermont is near the middle in this statistic. According to World Population Review, in 2024 the District of Columbia ranks highest with 42.29% of residents on Medicaid. Vermont is 17th, with 29.58%. The lowest is Utah with 13.79%
Are we 3 times sicker than people in New Hampshire?
Not according to the Kaiser Family Foundation. Vermont and New Hampshire are both well below the national average in percent of adults who smoke tobacco. New Hampshire has a slightly higher rate of age-adjusted invasive cancer and a higher rate of people who have been told by a doctor they have cardiovascular disease. On diabetes, Vermont has one of the lowest incidence rates in the country. New Hampshire is about average.
I suspect that the high cost of health insurance in Vermont is due to two main factors.
First, I suspect we have a top-heavy administrative burden — too many people drawing big salaries for managing data and adding needless complexity to the system, rather than providing clinical care.
Second, we have a large academic medical center that is continually absorbing more of the market, and is thus able to dictate prices with relative impunity, despite the best efforts of regulators.
On a personal note, I never thought I’d see the day again when some of my family would be uninsured. It happened in my youth and young adulthood until I lucked out and found employment that offered great insurance.
Now I am retired and on Medicare, but my wife and school age child have nothing. Bronze plans with $9,250 in-network annual deductibles would cost $577 a month for each of them, after deducting federal subsidies. No thanks. I could pay it and watch my retirement account rapidly dwindle, or we can save the money and live in fear.
I sure don’t see any help coming from the state of Vermont.
Read the story on VTDigger here: Ethan Parke: Vermont’s unaffordable health care.