Health Care Advocate: federal subsidy rollbacks and market shifts are driving Vermonters to drop coverage or face large premiums

Mike Fisher, the state Health Care Advocate, told the Senate Health & Welfare Committee that recent federal changes—particularly the end of enhanced premium tax credits—have raised premiums dramatically for many Vermonters and that state follow‑up is needed to protect access.

Fisher outlined three population groups at risk: low‑income immigrants who were able to buy coverage through Vermont Health Connect but lost eligibility or subsidies; people in the individual market who benefited from enhanced tax credits in prior years; and small‑group employers (under 100 employees) whose costs are rising because of adverse selection and self‑funding trends.

Using case examples, Fisher illustrated the human impact. He described an immigrant named Veronica Carlos who previously paid "about $12 a month" for coverage but after federal changes now faces monthly premium costs of roughly $1,300, and who relied on hospital financial assistance when care was needed. "She was able to buy a plan through Vermont Health Connect [in 2025]," Fisher said; "in 2026, due to changes in HR 1, her monthly cost for insurance for the same level is about $1,300." Fisher also gave a family example: "This family lost a little over $25,500 of subsidy in '26," demonstrating how the loss of enhanced credits can transform a household's budget.

Fisher said about 30,000 Vermonters were in the individual market in 2025 (roughly 6,500 above 400% of the federal poverty level) and warned many enrollees will shift to lower‑value plans or go uninsured. He explained technical strategies states used in 2025–26 (so‑called "silver‑loading") to draw federal dollars and boost the value of higher‑tier plans but said the end of the enhanced credits leaves large gaps.

On Medicare‑age Vermonters, Fisher described a couple who face much higher Part B/Part D and Medigap costs when they lose coverage options or guaranteed issue rights; he noted the state's Medicare Savings Program (MSP) changes that took effect Jan. 1 provide relief to about 14,000 low‑income renters but that serious cost burdens remain for many near the program thresholds.

Fisher also highlighted small‑employer market stress: healthier groups and employers are shifting toward self‑funding and stop‑loss arrangements, leaving smaller employers with worse risk pools and sharply rising premiums. He recommended the committee continue to seek updated enrollment and claims data from AHS, GMCB and insurers and to weigh targeted state responses (for example, subsidy backstops or program expansions) against fiscal constraints.

Committee members repeatedly raised the need for accurate, near‑term data: how many people lost eligibility or subsidies, how uncompensated care is trending, and what level of state fiscal support would be needed to replace lost federal subsidies. Fisher and members agreed AHS and other agencies should return with detailed numbers and options that clarify costs and tradeoffs.

This article draws on Fisher's testimony and the committee exchange during the Senate Health & Welfare meeting.