Care Board approved much smaller rate increases than insurers sought and outlines pricing reforms
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Summary
The Green Mountain Care Board reported lowering insurer rate requests for the exchange market, cited the end of federal subsidies as pressure on families, and described plans for reference‑based pricing, Act‑driven drug cost reporting and ACO certification rulemaking.
Board leaders told the Senate Health & Welfare Committee that insurer rate requests for fiscal‑year‑26 plans were significantly higher than the rates the board approved and that ongoing policy work aims to limit future growth.
Owen Foster said Blue Cross initially proposed double‑digit increases in some filings (for example, a 23% request on parts of the individual market) while the board approved substantially lower figures for the plans it regulates. On small group filings he said Blue Cross proposed about 13% but the board approved 4%; MVP requested 7% but the board approved lower averages for the markets the GMCB regulates. Foster warned the end of some federal subsidies on the individual market will increase pressure on families and could cause coverage losses that in turn harm hospital finances.
Emily Brown reviewed statutory steps the board is implementing to contain costs: Act 55’s 120% ASP cap on outpatient office‑administered prescription drugs, Act 68’s reference‑based pricing framework and expanded reporting requirements, and Act 15 updates to certificate‑of‑need thresholds. Brown said GMCB will approach rulemaking on reference‑based pricing in summer FY27 and aims for implementation in FY28, with a report on implementation due to the legislature in February.
Brown also described an IT/data upgrade under a rural health transformation fund grant that would expand the board’s analytic capacity; she said the board will bring the director of data to a future committee session to detail the project.
The committee requested follow‑up briefings on reference‑based pricing rule design and the practical effects of Act 55 reporting requirements; GMCB agreed to return with further technical detail.
