Earlier this month, health insurance companies asked state regulators for permission to increase their premiums by roughly 9% to 19% — among the highest increases in recent history.

That request drew alarm from residents, officials and lawmakers across the state — including U.S. Sen. Bernie Sanders, I-Vt.

“Individuals simply cannot afford large rate increases,” Sanders said in an interview with VTDigger. “Businesses can’t afford a large rate increase. And we want to understand what’s going on and what we can do about it.”

That desire culminated in a roundtable discussion in Burlington on Friday afternoon, where Sanders gathered some of Vermont’s top health care leaders — including the health commissioner and the heads of the state’s largest hospital and private insurer — to explain why care is getting increasingly unaffordable.

In a wide-ranging and at times tense conversation, Sanders exhorted participants to bring down costs, repeatedly asking, “What are we doing?”

U.S. health care is “a broken, corrupt system,” Sanders said. “What can we do here in Vermont?”

The attendees included Stephen Leffler, the president and chief operating officer of the University of Vermont Medical Center; Don George, the CEO of BlueCross BlueShield of Vermont; Jeffrey McKee, the CEO of Burlington’s Community Health Centers; Owen Foster, the chair of the Green Mountain Care Board; and Mark Levine, the state commissioner of health.

Gina Akley, the president of Barre-based stonework tool company Trow and Holden, was also present to explain how the rate increases would impact her company.

Akley told attendees that employees had a choice of taking company health care plans or receiving additional wages to buy their own. She said that the company, which brings in about $3 million a year, will spend roughly $200,000 this year on those costs combined.

“The costs are prohibitive,” Akley said. “And because I’m a union shop I don’t have any real negotiating power in terms of taking my costs down.”

Amid a thicket of statistics and jargon, health care leaders offered reasons why care in the state is so expensive and rising.  

“Health care costs are rising faster than nearly anywhere in the country,” Foster, the chair of the Green Mountain Care Board, told participants. “Meanwhile, access is down and health outcomes have not improved. They’ve been largely stagnant. So we’re spending more and more, and asking Vermonters to pay more, and we’re not seeing the outcomes we want from that investment.”

Participants offered various explanations for those increases and health outcomes. George, the CEO of BlueCross BlueShield Vermont, pointed to what he called the “deterioration of the health status” of many of the company’s roughly 200,000 clients.

Essentially, many people insured under BlueCross BlueShield have grown less healthy, George said, “which is causing an increase in the proliferation and use of prescription drugs, an increase in use of medical services, and certainly an increase in use in the more intensive health care services.”

Leffler, of UVMMC, cited shortages of nurses and other care providers, expensive prescription drugs, a shortage of long-term care facilities and an aging population.

“We need more younger Vermonters who need less health care, are not on meds, don’t have chronic illnesses,” Leffler said. “We’re seeing and feeling that every day.”

McKee, the CEO of Burlington’s Community Health Centers, gave some reasons why primary care providers were struggling: low reimbursement rates for Medicaid and Medicare and wage competition from UVMMC.

“Every time they have a union negotiation, I cringe and I watch and I’m like, how the heck are we going to keep up?” McKee said. “And how am I going to keep my staff?”

And Levine, Vermont’s health commissioner, pointed out that Vermont ranks high in nationwide health rankings, but noted that the state is still grappling with some of the downstream effects of the Covid-19 pandemic: homelessness, substance use, mental health challenges and deferred health care.

“Every single person (in the hospital) is way more complex than they were five years ago, or 10 years ago,” Levine said.

Identifying the cost drivers is one thing; fixing them, of course, is another.

Health leaders listed various workforce programs underway to bolster the ranks of nurses and other providers. Levine pointed to the state’s application for the AHEAD Model, a federal health care reform program that aims to reduce hospital spending and invest in primary care.

Foster, of the Green Mountain Care Board, pointed to recent legislation eliminating many types of prior authorizations for primary care and directing the care board to develop a prescription drug affordability program.

And, he added, the board is taking a close look at how much insurers pay providers for primary care, with the hope of making it a more appealing career path and relieving pressure on hospitals.

“We have to respect primary care for what it is, which is one of the most important medical professions,” Foster said. “And I don’t think we necessarily do as a society.”

Sanders, however, repeatedly expressed frustration at the pace of those efforts.

“I just do not feel that there’s a sense of urgency,” he said.