Vermont's Hospital Budget Hearings Sound Technical. The Consequences Are Not.

Part 1 explains why Vermont's hospital budget review matters to patients, workers and businesses. Part 2 examines UVM Health's systemwide finances. Part 3 looks at how individual hospitals frame their requests.

In 2025, the average price a commercial insurer paid for hospital care in Vermont was 453% of what Medicare would have paid for the same service. For outpatient care it was 503%. For a CT scan at some Vermont hospitals, it ranged from 870% to 1,433%. For some chemotherapy drugs, it exceeded 5,700%.

Those figures come from the Green Mountain Care Board's own staff analysis, filed this month as part of the annual hospital budget review. That review is now underway, and it is the mechanism by which the state decides how much revenue Vermont hospitals may collect next year and how fast their spending may grow.

The hearings are dense. They are packed with terms such as net patient revenue, payer mix, operating margin, commercial reimbursement and expense-growth benchmarks.

The stakes are considerably less abstract.

Hospitals are asking permission to collect and spend billions

The Board reviews the budgets of Vermont's 14 regulated hospitals. Hospitals submitted their fiscal year 2027 proposals by July 1, and the Board is holding public hearings through August.

Under 18 V.S.A. § 9456, the Board must establish a budget for each general hospital by September 15, with a written decision by October 1, when the hospitals' new fiscal year begins.

The Board is not directly setting every medical bill or insurance premium. It is placing limits on hospital revenue and commercial reimbursement while reviewing whether spending plans are affordable, financially sustainable and consistent with access and quality goals.

Vermont hospitals collectively proposed approximately $4.4 billion in fiscal year 2027 operating expenses. That figure excludes Brattleboro Memorial Hospital, which had not submitted a budget when staff prepared their analysis.

The Medicare comparison, and the objection to it

Hospitals will tell you — correctly — that Medicare generally pays less than what it costs to deliver care, and that a commercial price above 100% of Medicare is therefore expected everywhere in the country.

That objection explains a multiple. It does not explain the size of this one.

It also does not explain the trend. The Board's staff found that the average commercial price in Vermont grew 36.9% between 2019 and 2025. Over a similar period, bronze-level premiums in Vermont rose 95.3%, against 33.7% nationally. Vermont households now spend an estimated 15% to 20% of income on health care.

Nor does it explain concentration. Staff calculated a market concentration index of 7,608 for Vermont hospitals — roughly three times the federal threshold for a highly concentrated market. Five Vermont hospitals, a third of the total, operate as monopolies in their service areas.

Businesses do not escape the bill

An employer may technically pay the insurance company, but hospital costs do not vanish inside the transaction.

When insurance costs rise, businesses have limited choices. They can absorb the increase, charge employees more, raise deductibles, reduce benefits, limit wage growth or stop offering coverage.

A hospital budget can therefore become a payroll issue.

For employees, the effect may appear as a larger premium deduction, a higher out-of-pocket maximum or a plan that covers less than it did last year. For a small business owner, it may mean choosing between coverage, raises, hiring and investment.

The connection is not exact or immediate. Hospital revenue is only part of total insurance spending, and insurers, drug companies and independent providers also affect premiums.

The independent Liaison Team overseeing UVM Health notes that 44% of medical benefit cost falls outside Vermont's 14 regulated hospitals and outside the Board's authority — a point the team raises as a criticism of commercial insurers, not as a defense of hospitals.

But hospital costs remain the largest single component. The Liaison Team reported that roughly $200 million of revenue was taken out of Vermont's health care system in 2026 through a combination of pricing actions by the Board and Act 55, which limited prices for certain provider-administered drugs. Those reductions, the team said, translated into more favorable premium filings by BlueCross BlueShield of Vermont and MVP for 2027.

Affordability means little without access

Hospitals argue, with reason, that cutting revenue too aggressively can damage access. A financially unstable hospital cannot indefinitely maintain staff, equipment, buildings and services.

The public also has reason to ask what it is receiving for the money already spent.

The access data in this year's filings are not encouraging.

Porter Hospital reported that one of six measured specialties met or exceeded the benchmark for new patients seen within 14 days. Porter's overall result was 36% against a 51% benchmark.

Central Vermont Medical Center's roll-up matched its benchmark exactly, at 49% — but four of its ten departments fell short by 18 points or more, with radiation oncology 29 points below.

Across UVM Health, 10 of 12 departments fell below the benchmark for new-patient timeliness, and the share of referrals scheduled within three business days fell from 52.8% to 50.3%.

The Liaison Team put it in plainer terms: UVM Health primary care providers see 10 to 15 patients a day against a typical 20 to 25, "resulting in established patients waiting 31 days for an appointment and new patients waiting 33 days."

Emergency department waits tell a similar story. Vermont's median time from arrival to discharge for psychiatric patients is 387 minutes, against 259 nationally. At Brattleboro Memorial the median is 1,022 minutes — roughly 17 hours.

On quality, staff found Vermont hospitals "perform worse on the Safety of Care and Mortality domains as compared to hospitals nationally," and that two-thirds of Vermont's prospective-payment hospitals took a federal penalty for hospital-acquired conditions in fiscal 2026.

That turns the budget debate into a practical question: are Vermonters being asked to spend more merely to preserve the current system, or will these budgets measurably improve their ability to get care?

Public testimony can matter, and it does not require an accountant

The Board already has the financial statements. What it may not have is a picture of how those numbers translate into daily experience.

A patient told to wait four months for a primary care appointment tests a hospital's claim that access is preserved. A business owner can describe premium increases, benefit reductions or hiring decisions driven by health insurance costs. A nurse or physician can say whether staffing reductions produced efficiency or simply moved the burden to overtime, delays and burnout.

Useful testimony is specific. Dates, waiting times, premium changes, benefit changes, closed services and actual bills carry more weight than a general statement that health care is too expensive or that hospitals are important.

A special public comment period on the FY27 hospital budget review is open through Friday, September 11. Comments may be submitted in writing; appearing in person is not required. The Board can be reached at GMCB.Board@vermont.gov or 802-828-2177, and comment instructions are posted on the Board's website.

Hospitals bear the burden of justifying their budgets. Public comment helps the Board judge whether the presentations match conditions outside the hearing room.

The calendar

  • July 1 — Hospitals submitted FY2027 budgets
  • August — Public budget hearings. The UVM Health system presented August 3; UVM Medical Center, Central Vermont Medical Center and Porter August 5; Rutland Regional August 7. Remaining hospital dates and remote meeting links are on the Board's Hospital Budget Review Schedule.
  • September — The Board deliberates publicly and must approve, modify or deny each budget by September 15
  • September 11 — Special public comment period closes
  • October 1 — Written budget orders delivered; hospital fiscal year begins

Why this matters

These hearings will not solve Vermont's health care crisis. They will not determine every premium, bill or appointment.

They will determine how much revenue hospitals may pursue, how fast expenses may grow, and whether hospital promises on affordability and access are credible enough to approve.

That makes the process relevant to nearly everyone who pays taxes, carries insurance, employs workers or may someday need a hospital.

The language is technical. The consequences land in household budgets, business payrolls and hospital waiting rooms.