VERMONT

Overview

Vermont has been active in cost containment and transparency through a number of state planning initiatives, rate and premium control, and the VHCURES all-payer claims database. Vermont also attempted to be the first state to operate a single-payer healthcare system, however, the state gave up on the plan in 2014. In the 2017 legislative term, Vermont proposed legislation to create a public option, increase transparency on prescription drug pricing, and curb the State’s spending of prescription drugs to no higher than the Department of Veteran Affairs. However none of these proposals carried on into the next legislative term.

In the 2019 legislative term, Vermont passed a host of healthcare legislation, including laws to protect consumers should the Affordable Care Act (ACA) be repealed.  For example, Act 63 (HB 524) adopts into Vermont law certain federal consumer protections for health insurance plans like the prohibition on preexisting condition exclusions and a ban on annual and lifetime limits.  Additionally, should federal cost-sharing reduction payments to insurers be suspended or discontinued, Act 19 (S 89) allows health insurers to offer non-qualified reflective health benefit plans to individuals and small groups at all metal levels.

Vermont also went beyond protecting ACA requirements.  It enacted Act 17 (S 53) which requires its state agencies to determine which providers constitute primary care providers and the percentage of health care spending currently allocated to primary care by certain public and private payers. It also prohibited health insurance plans from imposing prior authorization requirements for all counseling and behavioral therapies associated with medication-assisted treatment and for prescription drugs for a patient receiving medication-assisted treatment if the dosage prescribed is within the U.S. Food and Drug Administration’s dosing recommendations (Act 43 (SB 43)).  Vermont also targeted Association Health Plans (Act 63 (HB 524)), accountable care organizations (Act 52 (S 7)), and financing and delivery of Medicaid home- and community-based services (Act 52 (S 7)), among other areas of healthcare policy.

In the 2018 legislative term, Vermont passed legislation to allow the wholesale purchase of prescription drugs from Canada and to create a state mandate for minimum essential health care. The mandate to require all residents to have health insurance will take effect in January 2010 and is designed to keep healthier people enrolled in the states’ Affordable Care Act insurance marketplaces and premium prices low. In addition, the Legislature also passed a drug price transparency bill (S 92) which requires state officials to identify 15 drugs whose wholesale acquisition costs rose by 50 percent or more over the last five years, and 15 medicines that rose 15 percent or more over a 12-month period. The drugs’ makers must justify the price increases to the state’s attorney general and the information is made public.

State Action




2020 Legislative Session: 1/8/2020 - 5/8/2020 (2019-2020 term). *Current session bill updates are ongoing. Check back weekly for updates.

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© 2018-2020 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

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© 2018-2020 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.
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Additional Resources

STATE BUDGET

Vermont’s fiscal year begins on July 1 and end on June 30 the following year. Vermont enacted its 2020 budget during the 2019 legislative session. To view Vermont’s FY 2020 Budget, click here.

REGULATION & ENFORCEMENT

  • On January 17, 2017, the commissioner of the Department of Financial Regulation announced that MVP Health Insurance Company has paid the state of Vermont $70, 500 in administrative penalties and $158, 915 as reimbursement to Vermont residents for consistent overcharging for colorectal screenings.
  • Administrative orders issued by the Department of Financial Regulation respecting insurance market conduct can be found here.

KEY RESOURCES