Addressing Healthcare Affordability
Healthcare is one of our major cost-of-living issues in Vermont. And, like other areas of unaffordability, Vermont stands out among our neighbors as being especially egregious. Typical health insurance premiums in Vermont can cost three times more than the same plans in neighboring states. For example:
The average “benchmark” silver health insurance plan premium in Vermont is a staggering $15,600 per year, the highest in the country according to the Kaiser Family Foundation, and more than three times higher than $4,800 per year for the same plan in New Hampshire.
The same disparity exists in the small business health insurance market. A group insurance policy for just five employees can cost over $32,000 more in Vermont compared to a similar plan in New Hampshire.
According to a 2025 Green Mountain Care Board report, between 2018 and 2025 the marketplace premiums in Vermont experienced a compound annual growth rate between 10% and 15% per year, compared to -1% and 2% nationally. Over those 7 years, premiums for the average lowest cost silver plan in Vermont grew 169%!
So, how did we get into this situation? During the 1990s, Maine, New Hampshire, and Vermont all adopted similar restrictions on health insurance pricing. The Vermont Legislature expanded those policies to pursue a government-run “single-payer” healthcare system. Governor Peter Shumlin officially ended that effort in December 2014, concluding it was not financially viable. Yet many of the insurance market policies developed during that period remain in place today!
Meanwhile, both Maine and New Hampshire concluded that several of those restrictions were producing unintended consequences, including higher premiums, fewer insurance choices, and declining participation by younger adults. As a result of these findings, both states moderated and modernized their policies, thus reducing their costs. According to the Maine analysis: After these changes were introduced, "individuals in their early 20s saw premium reductions approaching $5,000 annually, while individuals in their 60’s experienced premium reductions of more than $7,000. As premiums declined, younger and healthier individuals returned to the market, enrollment increased, and the individual insurance market stabilized." The Vermont legislature has stubbornly resisted these necessary changes.
This biennium the state Legislature took one small step to begin addressing the healthcare affordability problem. Act 68 of 2025 required the Green Mountain Care Board to implement reference-based pricing. But, this still does not address the root cause of the affordability problem -- lack of insurance options. A very viable plan to reform Vermont’s healthcare policies was proposed by Governor Scott this year as H.585. After multiple changes in the House Heath Care committee the bill failed to pass the Senate.
The good news is that Governor Scott has just signed Executive Order 05-26. It focuses on expanding affordable insurance choices, expedites much needed regulatory reforms to bring Vermont's policies closer to the mainstream approaches already used successfully in Maine and New Hampshire, and sets the stage for future legislative action that will restore options and lower prices for small businesses, workers, and families. You can watch Governor Scott explain his Executive Order at his press conference this past week by clicking HERE. Here’s a summary of the EO:
Age Rating - Allow up to 20% age-based premium adjustments to lower costs for younger Vermonters to encourage them to get back in the insurance market, thus increasing the pool of insured people and thus reducing rates for everyone.
Non-Tobacco Incentives - Develop incentives for healthy choices to enable lower premiums for non-tobacco users.
Capture Available Federal “Innovation Waivers” Funding - Pursue what 20 other states are doing to lower premiums for both older and younger Vermonters and create re-insurance pools.
Association Health Plans and Stop-Loss Rules - Revise regulations to give small employers more options similar to large employers to increase affordability.
Protect the Vulnerable - Maintain guaranteed-issue, no medical underwriting to continue vital protections for vulnerable populations
The Executive Order is a good start, but there are still significant statutory policies that the Legislature will need to change. It will require new and effective leadership in the House and Senate to listen to these ideas and move them forward. Affordable health care in Vermont depends upon it.
Stay tuned and stay engaged.
I remain honored to be your Representative,
Rob North
Addison, Ferrisburgh, New Haven, Panton, Vergennes, and Waltham
