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Hospitals warn S.190 could harm critical access facilities as committee debates outsourcing and cost‑sharing fixes
Summary
Hospital representatives told the House Health Care Committee that statutory price caps and changes to how Medicare cost sharing is treated for outpatient services could threaten small and critical access hospitals; the bill directs a GMCB working group to recommend mitigation strategies and orders reporting on outsourcing.
Testimony before the House Health Care Committee on April 28 focused at times on provisions in S.190 about hospital outsourcing and Medicare outpatient cost‑sharing for critical access hospitals.
The bill directs the Green Mountain Care Board to convene a working group — including hospital and insurer representatives — to develop recommendations to mitigate the effects of a federal policy that leaves Medicare beneficiaries responsible for 20% of outpatient charges. The working group must report projected impacts to patients, Medicare supplement premiums and the state budget by Jan. 15, 2027.
Devin Green, representing the Vermont Association of Hospitals and Health Systems, said hospitals support transparency but urged caution on statutory fixes. He warned that reducing hospital charges to Medicare levels would substantially reduce commercial revenue because many commercial contracts are based on charges, not reimbursements, and that could imperil critical access hospitals. "If you bring down our charges to the Medicare amount, commercial insurance will be a fraction of that," Green said, adding that such an outcome could lead to closures.
Committee members pressed hospitals on reporting practices and why some outsourced clinical services had not been obvious in earlier budgets. Several members expressed frustration that outpatient charge practices had not been transparent to the Legislature earlier and asked for clearer public data. Hospitals said the current bill’s reporting requirement and the GMCB working group are appropriate starting points; they favored a stakeholder process and federal advocacy for a national fix.
The committee did not adopt regulatory changes at the hearing; members instructed staff to obtain additional exhibits, ask the GMCB and hospitals to provide clearer documentation about outsourcing and chargemasters, and to pursue federal engagement on Medicare cost‑sharing rules.
