HouseHealthcare hears testimony to accelerate reference‑based pricing for two pools in S.190 amendment

The HouseHealthcare committee on May 7 heard testimony supporting an amendment to S.190 that would accelerate reference‑based pricing for two insurance pools and direct any hospital spending reductions into targeted markets.

Kai Samson, Commissioner of DFR, told the committee the state’s regulators and hospitals have shifted sharply in the past year toward affordability‑driven actions. "This ship is turning," Samson said, describing recent Green Mountain Care Board enforcement and DFR intervention that he said produced "real bankable savings" reflected in lower QHP rates.

Owen Foster, chair of the Green Mountain Care Board, said the board’s statutory duty is to balance access, affordability and hospital solvency. Foster said he supports draft 1.1’s approach that would let the care board determine how much hospital spending can be reduced for fiscal year 2027 and then apply resulting savings to two vulnerable markets: the qualified health plan (QHP) marketplace and the VHII/Beehive pool. "If you do it as contemplated here, it will go to QHP and VHII. We know it will reduce prices in Vermont 100%," Foster said.

Foster, citing a consultant engagement and prior analyses, said there is work underway that could yield substantial savings; he referenced consultant estimates in the low‑hundreds of millions over two years. He and Samson both urged the committee to clarify statutory language in draft 1.1 that could blur which regulator has authority over which rates, and Samson recommended separating DFR and GMCB responsibilities in the text.

Both witnesses warned of downstream risks. Foster said utilization and hospital revenue are already shifting and that reduced utilization can hurt hospital finances; he singled out critical access hospitals and questioned whether a multiplier in statutory language should remain. Samson flagged potential federal subsidy effects and said any state actions that reduce QHP costs should be pursued alongside study and possible pursuit of a §1332 waiver so the state could preserve or capture federal savings.

Members pressed witnesses on implementation timing for 2027 and for the post‑2027 period. Foster urged flexibility for the board in 2028 to avoid legislative caps that might limit future adjustments, while others expressed concern about volatility if the on‑ramp toward reference‑based pricing stalled.

The committee recessed for a break at 10:30; no formal vote or amendment adoption was recorded in the transcript.

The hearing continues with additional testimony and legal review expected later in the process.