by Guy Page

At a State House press conference Wednesday, January 28, Gov. Phil Scott and state health officials announced an ambitious overhaul of Vermont’s “fragile” healthcare system, warning that the current model is in crisis and unsustainable for the state’s aging population. The plan aims to lower insurance premiums and improve rural access, leveraging a potential $1 billion in federal funding over five years to modernize service delivery.

Addressing root causes

Governor Scott emphasized that the push for reform is driven by an affordability crisis that is pricing residents out of the state. He noted that Vermont currently faces some of the highest insurance premiums and care costs in the country, which makes it difficult to attract the working-class families the state needs.

“Instead of throwing more money at the problem, we need to address the root causes and fix the system,” Governor Scott stated during the briefing.

A system “built for the past”

Secretary Jenney Samuelson of the Agency of Human Services (AHS) argued that the state’s healthcare infrastructure is no longer aligned with its current demographic reality. The existing system was designed for an era of in-person, hospital-based care, whereas today’s Vermont is older, more rural, and struggling with widespread workforce shortages.

“The system we have today is expensive in part because it is built for a Vermont that is very different than the Vermont we have today,” Samuelson explained. To bridge this gap, the administration’s plan focuses on several key initiatives:

• Strengthening primary care: Investing in “community health teams” to serve as the front door of the system.

• Expanding telehealth: Using technology to deliver care more efficiently to rural residents.

• Reducing duplication: Moving away from a model where every service is offered everywhere, and instead placing the right care in the right location.

One Big Beautiful Bill’ Rural Health Transformation Fund plays big role

A central component of the reform is the Rural Health Transformation Fund, which has already granted the state an initial $195 million. Accessing the full $1 billion over five years requires Vermont to meet specific federal benchmarks for system-wide reform, Samuelson said.

Legislative efforts, such as House Bill 585, also seek to increase accountability by placing two governor appointees on the boards of domestic non-profit insurers and implementing site-neutral billing to prevent hospitals from overcharging for basic lab work.

Closing the briefing, Samuelson underscored the long-term vision of these difficult structural changes: “We’re not just managing today’s costs. We’re building a health care system Vermonters can afford tomorrow,” she concluded.

Mobile dental clinics for Vermont? Maybe…..

VDC asked if the new approach to healthcare would include mobile clinics for rural dental care. Samuelson responded: “It can include dental practices. When we applied for the grant, one of the things that we identified was the need to take care to where people are. We left it open to work with our health care providers in Vermont to determine that care can and should be based

on the needs of Vermonters. It can be substance use, it can be primary care, it can be dental.

We don’t want to get ahead of ourselves. We need to work with our providers in the state to determine the best options. 

Specific to mobile dental care: “We have seen that dental care through mobile units has been very successful. Several [providers] currently do it although some of them are struggling to continue, given the workforce shortages to keep it going,” Samuelson said.

Scott calls for immigration enforcement ‘de-escalation’

In response to persistent questioning by reporters – notably Boston Globe reporter Paul Heintz, formerly of Seven Days and VTDigger – Scott called for a “de-escalation” of federal immigration tactics following a tragic shooting in Minnesota, describing recent enforcement actions as a “roundup” rather than a targeted approach to public safety. 

The Governor expressed deep concern regarding recent video footage of federal agents in Minneapolis, calling the shooting of a second protester a “tragic incident that was avoidable”. He suggested that the situation resulted from an “error in training” and urged federal authorities to “tone it down” and work with the community rather than using paramilitary actions. He did not, however, repeat an earlier claim that the killing might have been ‘murder.’ 

Scott voiced clear frustration with the current federal strategy: “I’m more interested in seeing a different approach… for accomplishing what I thought they were setting out to do—to deport the worst of the worst, those who are criminal, those who are violent… but at this point in time, it just looked like a roundup to me”.

The Governor also addressed bills intended to rein in federal officials, specifically referencing bills S.208 and S.209. These measures aim to limit the locations of civil immigration arrests and prohibit law enforcement officers from wearing masks during operations. Scott reiterated his strong opposition to law enforcement officers wearing masks, stating that agents “should be visible”. He emphasized that he needs to see the bill, if passed by the Legislature, before deciding on whether to sign it.

Congressional leverage

Scott suggested that Congress should use its “power of the purse” to negotiate a change in how the Department of Homeland Security operates if their current strategies do not “pass muster”.

In response to VDC’s question about whether he would advise Minnesota Gov. Tim Walz to release incarcerated immigrants to ICE, Scott repeated what he said several times during the press conference: the feds and the State of Minnesota need to de-escalate and work things out.