Get AI Briefings, Transcripts & Alerts on Local & National Government Meetings — Forever.
Ways & Means hears proposals to shore up health coverage after federal credit rollback
Summary
On April 28, the Ways & Means Committee reviewed draft bill 26-0804, which would expand a small‑employer premium tax credit, create state premium assistance for households above 400% of the federal poverty level, and further expand Medicare savings programs to reduce Medicare costs for low‑income Vermonters.
The Ways & Means Committee on April 28 heard a detailed presentation from the Office of the Health Care Advocate on draft bill 26-0804, which the office says is intended to blunt the effects of the end of enhanced federal premium tax credits.
Mike Fisher, Health Care Advocate, told the committee the enrollment slides tell "a story of a disaster," saying the recent open‑enrollment data show a substantial exodus from the individual market and a large shift to lower‑value plans. Emma Savins, a health policy analyst, said the bill contains three initiatives: a small‑employer premium tax credit, expanded state premium assistance for households above 400% of the federal poverty level (FPL), and further expansion of Vermont’s Medicare savings programs.
The proposal for small employers would extend eligibility beyond the current program (which is limited to businesses with 25 or fewer full‑time employees) to employers with up to 100 employees and would target employers that pay 50% or more of employee premiums. Fisher said the small‑group market is under significant pressure from rising premiums and that the state has fewer regulatory tools in the small‑group market than it does for the individual market.
On the individual‑market side, Savins noted that the enhanced federal advanced premium tax credits that were in place during and after the pandemic ended on Jan. 1, 2026, removing premium tax credit eligibility for households with incomes above 400% FPL. She told members that, for 2026, the 400% FPL threshold equals $63,840 for a household of one and $132,000 for a household of four. The bill would add Vermont premium assistance for households above 400% FPL so that those households would not pay more than 10% of income for the second‑lowest‑cost silver plan, subject to the condition that they purchase coverage through Vermont Health Connect.
Savins cited a DIVA analysis presented to the Legislature in January 2025 that estimated fully covering the over‑400% population could cost roughly $5.6 million; she emphasized that the analysis was done in late‑2024 and is sensitive to modeling assumptions. Fisher and Savins also described broader market effects: they said many higher‑risk enrollees remain, while people with low claims are leaving or downgrading to bronze plans, a combination that could further destabilize premiums.
The committee also discussed the Medicare Savings Program (MSP). Presenters said QMB (Qualified Medicare Beneficiary) currently covers Medicare Part B premiums (about $202.90 a month) and cost‑sharing for qualifying enrollees, and QI‑1 covers Part B premiums for another cohort. The language under consideration would raise QMB eligibility toward 200% FPL and move QI‑1 closer to the federal maximum (about 262% FPL). Savins offered a rough cost estimate for a broader MSP expansion near $10 million and cited previous investment the state made (about $5 million) that the presenters said led to substantial taxpayer and beneficiary savings.
Committee members asked for detailed participation counts and for DIVA or Vermont Health Connect tables to verify enrollment, migration between plan metal levels, and fiscal impacts. The Office of the Health Care Advocate said it lacks precise counts for the small‑employer credit and recommended following up with Vermont Health Connect and DIVA for the empirical numbers. The chair signaled the committee will pause to receive Pat’s numerical tables and further fiscal analysis before making decisions.
The committee did not take action on the language at the meeting; members asked follow‑up questions and requested more detailed fiscal tables from the legislative fiscal office and DIVA. The committee recessed to await further numerical briefing.
