Affordability Matters: A Call for Change in Vermont’s Health Care System

By Don George, President & CEO, Blue Cross and Blue Shield of Vermont

For over four decades, Blue Cross VT has stood alongside Vermonters—innovating and investing in better health care. But today, that mission is being pushed to the brink by unsustainable increases in health care costs that impact all of us.

Vermonters now spend 19.6% of their income on health care, compared to the national average of 7.9%. This is a clear sign of a system in distress and in need of reform. It shows we are operating in an environment where the current structure simply does not work. Not for us. Not for Vermonters. Not for the future of care.

This isn't just our story. It’s Vermont’s story. It’s why today, I’m proud to share Affordability Matters: A Call for Change in Vermont’s Health Care System.

A Crisis Decades in the Making

The headlines might focus on Blue Cross VT’s recent financial challenges, but what we’re all facing is bigger than any single organization.

The health care cost crisis has been growing for years. Prices for hospital services and prescription medications have skyrocketed. In 2024, our member reserves fell to $58.4 million—even with a $30 million loan—requiring oversight by state regulators. We pay $35 million per week in claims for our members, driven by the rising intensity and complexity of care. And those costs are climbing without signs of slowing down.

What does that mean for each of us? It means higher premiums, bigger bills, harder choices, and in some cases, care delayed or skipped altogether. When 15% of our members, those with the most complex conditions, account for 54% of total claims cost, we must both support these individuals and design a system that’s sustainable for all of us.

What We’re Doing About It

We are not standing still. We've taken immediate and long-term actions to stabilize our organization and fight for affordability. These include:

• Enacting a comprehensive capital recovery plan with Vermont regulators
• Leveraging our affiliation with Blue Cross Blue Shield of Michigan to strengthen our deep local presence in a marketplace dominated by for-profit competitors
• Keeping our administrative costs the lowest of any insurer in Vermont and the lowest of any Blues plan in the country
• Advocating for stronger pricing oversight—including hospital and payer-specific revenue caps—to address unchecked cost growth and promote affordability
• Continuing to deliver high-quality health care coverage, personal member support, and local customer service

But fixing Vermont’s health care system can’t be done by one insurer. We need systematic reform that addresses both cost and delivery. We need price transparency and payment innovation. We need community action, business engagement, and policy leadership. Most of all, we need everyone to play their part because this isn’t just about spreadsheets or systems, it’s about people. It’s about whether the people in our great state can afford to get the care they need, when they need it.

The Strength of Vermont is Its People

What gives me hope is that Vermonters are becoming aligned. Since sharing our story earlier in the year, we’ve seen meaningful engagement from policy leaders, business owners, and families across the state. The message is clear: ‘Enough. We must do better.’

To those voices, I say thank you. Let’s keep going.

Through Affordability Matters, we’ll share facts, highlight progress, and invite all of you into the conversation. Because real, lasting change starts when we recognize the power of community, the value of transparency, and the necessity of collaboration.

Let’s Build Something Better

Health care is personal—and so is this work. At Blue Cross VT, 92% of our employees are on our health plans, and they pay for that coverage out of pocket. We face the same rising costs as the communities we serve.

This moment demands more than acknowledgement. It demands the kind of action that delivers high-quality care coverage without bankrupting families, small businesses, or future generations. Share what you learn. Use your voice. Ask hard questions. Talk to your legislators. Help us build a better path forward—one that is affordable, accessible, and sustainable for every Vermonter.

Because Affordability Matters.