The State of Health Care as the Legislature Gets to Work
As the 2026 legislative session begins, health care costs remain one of the most pressing challenges facing Vermont employers. Open enrollment closed last week, and early feedback from Vermont Chamber members is consistent: costs are crushing, and there are no easy choices. Large group plans increased by an average of roughly 15 percent, small group plans also rose, and the loss of federal subsidies forced many sole proprietors and employers into impossible decisions to cover plans they couldn’t afford or drop coverage all together.
While rising health care costs are a national issue, Vermont remains an outlier on both cost and competitiveness. Vermont has just two insurance carriers and offers only 13 plans, while New Hampshire employers can choose from 78. Monthly family premiums in Vermont can exceed $2,756, significantly higher than comparable plans just across the border. For small employers, the impact is severe: a five-person business can pay more than $8,500 per month for coverage alone. These differences are not abstract. They show up in constrained wage growth, delayed investments, and difficult conversations with employees every renewal cycle.
Last year, the Legislature took meaningful steps to address health care costs, resulting in more than $200 million in hospital operational savings. Hospitals have identified another $100 million in potential reductions over the next two years. In that period hospitals will transition to reference-based pricing, an important structural reform. These changes matter, but they take time to translate into lower premiums, and employers are feeling the strain now.
This session must focus on what comes next to continue bending the cost curve. Strengthening primary care is a critical conversation. Greater access to primary care can reduce reliance on high-cost hospital services, improving outcomes while lowering system-wide costs. A bill under consideration in the Senate explores financial supports for primary care that can’t come on the back of already stressed commercial payers. This plan also raises a fundamental question: How do we attract and retain physicians in Vermont if broader economic conditions make it difficult to live and work here? Housing availability and tax policy are not side issues; they are central to solving Vermont’s health care workforce challenges.
Lawmakers are also considering a far-reaching bill related to private equity in health care with significant implications for providers, patients, and employers alike. Given its scope, the House Health Care Committee will take significant time to fully understand its implications and work through serious unintended consequences.
Any serious effort to reduce premiums must address the size and stability of the insurance risk pool. This would include reestablishing association health plans that employers relied on for decades to access competitive plans. Additional proposals could bring teachers and municipal employees into the pool. As businesses and working Vermonters are being asked to make increasingly difficult choices, it is essential that those whose salaries are supported by tax payments from employers and employees alike are open to actively partnering in solutions.
CONNECT WITH OUR HEALTH CARE EXPERT
Megan Sullivan
Vice President of Government Affairs
Economic Development, Fiscal Policy, Healthcare, Housing, Land Use/Permitting, Technology

