Green Mountain Care Board: Vermont health costs unsustainable as insurers, hospitals strain

The Green Mountain Care Board told state legislators on Thursday that Vermont’s health spending has outpaced the rest of the country for years and that the board’s authority is limited to a narrow slice of insurance and hospital financing.

“The role of the GMCB ... is often sometimes confused,” Owen Foster, chair of the Green Mountain Care Board, told the committee. “We are an independent agency ... and we're quasi judicial.”

The board used a two-hour presentation to outline what it regulates — hospital budgets, certificates of need and rate increases on qualified health plans — and what it does not, including Medicare, Medicaid, Medicare Advantage and most self‑insured employer plans. Foster emphasized that the board directly regulates only the qualified health plan market, which covers roughly 60,000 people in Vermont, a fraction of the state’s total insured lives.

Why it matters: the board said Vermont faces a sustainability crisis. Commercial prices and insurer claims have spiked recently while access and population health measures have not improved in step. Blue Cross Blue Shield of Vermont, the state’s dominant insurer, has reported multi‑million‑dollar monthly losses and a capital metric the board described as well below standard targets, risks the board said could ripple through hospitals and community providers.

Major points from the board’s briefing

- Scope and limits: Foster said the board lacks authority over Medicare and Medicaid rates and most self‑insured plans. The board’s regulatory levers are principally hospital budget review, limited insurer rate review for the qualified health plan market, ACO oversight and certificates of need.

- Total cost of care: The board explained Vermont participates in an all‑payer model and sets a Medicare total cost‑of‑care benchmark under the federal agreement.…