Lawmakers, advocates and insurers debate reference‑based pricing, CON thresholds and drug costs as drivers of Vermont’s expensive health care

Stakeholders testifying to the Vermont House Committee on Health Care aired competing policy ideas to address why Vermont has among the highest health care costs in the country: reference‑based pricing, changes to certificate‑of‑need rules, stronger transparency on outpatient drug pricing and attention to market structure that is shifting risk out of state‑regulated markets.

"Reference‑based pricing could help rationalize prices across providers, but you wouldn't want to do it just for one payer or overnight," said Sarah Teachout, director of government and media relations for Blue Cross and Blue Shield of Vermont. Teachout told the committee Blue Cross supports the concept in principle but urged phased implementation and broad application across payers to avoid unintended cost shifting that could jeopardize hospital budgets.

Mike Fisher, the state's Health Care Advocate, urged legislative action to develop a theory for how Vermont will pay for the health care system it wants. Fisher suggested raising the threshold for certificate‑of‑need (CON) review to encourage more competition in some areas, while warning that CON reform requires nuance to…