House advances S190 to empower Green Mountain Care Board to start reference-based pricing in 2027

The Vermont House passed Senate Bill 190 on a concurrence vote after amending the Healthcare Committee report, sending the measure to the Senate with a proposal of amendment. Representative Black (member from Essex), who presented the strike-all amendment, said the bill implements parts of Act 68 by allowing the Green Mountain Care Board to commence reference-based pricing in hospital fiscal year 2027.

Representative Black said the measure aims to lower insurance costs for people least able to afford care, reduce property-tax pressure tied to school health costs, and help hospitals by stabilizing revenues. "This bill will do four things," Representative Black said on the House floor, listing authority for FY27 reference-based pricing, coverage of qualified health plans, relief for school employee insurance (VHI), and protections tailored for community hospital needs.

The bill instructs the Green Mountain Care Board to use reference-based pricing with a goal of bringing hospital commercial prices toward the national median by 2030, requires hospitals and insurers to report rates as a percentage of Medicare and in dollars-and-cents, and directs hospitals to disclose outsourced clinical services in FY27 budgets. Representative Black also described changes to appeals language and an exemption from bargaining-group negotiations related to establishing reference-based pricing.

Supporters stressed affordability and accountability. "There should be a limit, a rational, transparent, publicly accountable limit," a member voting for the bill said, urging colleagues to reduce premiums for individuals, small businesses and school employers. Opponents and several questioners pressed for fiscal detail: the floor acknowledged that no statewide premium-savings estimate is yet available because the Green Mountain Care Board has not completed hospital budget orders and related modeling.

Representative Black cited marketplace figures to describe scale: about 64,000 people in the individual qualified health plan market and roughly 34,000 in Vermont Health Insurance, for about 97,000 covered by those plans, and said federal subsidy changes have cost Vermont over $60 million and led to more than 5,000 disenrollments by April 2026. The presenter and committee witnesses, he said, expect more precise fiscal impacts once the board completes its budget review process.

A roll-call tally taken on the proposal to amend and advance the bill recorded 87 yes and 44 no; the House ordered third reading and later passed the bill in concurrence with the amendment. The House also voted to place S190 in all remaining stages of passage and messaged its action to the Senate.

The bill delegates the detailed rate-setting work and many final fiscal decisions to the Green Mountain Care Board and the Department of Financial Regulation; several members said they look to the board’s forthcoming hospital budget orders and public reports to quantify savings and distribution of impact. The Senate will now consider the House’s proposal of amendment.