Senate Health & Welfare signals concurrence on S.190 to curb hospital prices while protecting hospitals

The Senate Health & Welfare Committee reviewed S.190, a bill returned from the House, at its May 28 meeting and conducted a straw poll signaling concurrence with the House amendments.

The chair opened the session by describing S.190 as part of a sequence of reforms (Act 167, Act 51 and Act 68) meant to lower hospital and insurance costs while keeping hospitals financially sustainable. "This this bill is something important to us in this room," the chair said, urging the committee to consider the House changes.

Jen Harvey of the Office of Legislative Council walked members through the House markup. She said the House added a statutory direction for the Green Mountain Care Board to use reference‑based pricing and to reduce hospital prices toward the national median by hospital type by 2030, using nonpartisan measures that express hospital prices as a percentage of Medicare to evaluate progress. The House also removed a single uniform 250 percent cap and instead authorized the board to set item‑ and hospital‑specific percentage limits for qualified health plans (QHPs) and for plans covering school employees organized under the Vermont Education Health Initiative (VHI) for hospital fiscal year 2027.

Harvey said the markup retains the committee’s balance‑billing prohibition (hospitals may not charge patients amounts beyond the board‑specified reimbursement except for plan cost‑sharing) and requires carriers using non‑fee‑for‑service arrangements to adjust their methods to reflect any reimbursement limits the board sets. She described a session‑law approach that puts the provisions in effect for fiscal year 2027 while the Care Board develops permanent rules.

The House version also added language authorizing the Department of Health Access, in consultation with the Department of Financial Regulation, to pursue a state innovation waiver under "section 1332 of the care act" to establish a reinsurance program and to seek federal pass‑through of amounts attributable to premium tax credits. Harvey said the House kept prior provisions requiring hospitals to report outsourcing sources and retained the committee’s data infrastructure and health system performance tool provisions.

Members pressed for estimates of savings and distributional effects. A committee member cited prior modeling and out‑of‑state examples, saying, "they've saved over $40 million, like $48 million," referencing Montana’s experience in the public‑employee market. Committee discussion emphasized uncertainty: members and staff noted estimates for Vermont ranged from tens of millions of dollars to a possible $80–$90 million overall, but speakers stressed final impacts depend on which populations are included and how the Care Board sets item‑ and hospital‑level percentages.

Committee discussion also focused on the effect on Medicare beneficiaries and critical access hospitals. Harvey summarized House language directed at outpatient charges for Medicare beneficiaries and said the markup directs critical access hospitals to identify outpatient services where charges are five times or more the Medicare allowed amount, to disclose that information publicly and to file disclosure materials with the Care Board for approval before posting. The House removed the committee’s earlier proposed restriction that would have prohibited Care Board budget actions on the issue in fiscal year 2027 and instead directed the board to consider proposals from critical access hospitals and ensure consistency with ongoing hospital transformation efforts.

Committee members reviewed available market counts but noted enrollment data were incomplete: an on‑the‑record Joint Fiscal figure cited roughly 70,000–85,000 people in the individual and small‑group QHP markets and about 36,000 in the VHI/beehive plans; speakers cautioned those numbers are approximate because current enrollment reporting was unavailable at the time.

After members declined to offer further amendments, the chair conducted a straw poll to concur with the House proposal for S.190. The chair said she would carry the committee’s message to the floor; no formal roll‑call tally of the straw poll was recorded in committee minutes.

The committee did not adopt an amendment or refer the bill to a conference committee during the meeting; the chair indicated she would present the amended bill on the chamber floor later in the day.

Next steps: the chair will present the committee’s concurrence message to the full Senate and the bill is likely to be debated on the floor; the Care Board will need to complete rulemaking and modeling to quantify premium impacts and to set any site‑specific reimbursement percentages for hospital fiscal year 2027.