Earlier this year, a consultant issued a report recommending sweeping changes to the state’s health care system — proposals that ranged from building more housing to cutting certain services at specific hospitals. 

At a meeting of lawmakers and state health officials late last week, Sen. Ginny Lyons, D-Chittenden Southeast, questioned Green Mountain Care Board Chair Owen Foster and Secretary of Human Services Jenney Samuelson on that report. 

Of the scores of recommendations, Lyons, the chair of the Senate Committee on Health and Welfare, asked what would be the simplest for the Legislature to implement: “Which is the low-hanging fruit?” she said at the Friday meeting. 

The officials’ answers — which included proposed reforms to hospital regulations, state emergency medical services and electronic medical records — now seem poised to form key planks of the health care agenda in the upcoming legislative biennium.

As Vermont’s population has aged, the state’s health care system has appeared increasingly unsustainable. Private health insurance premiums are among the most expensive and fastest-growing in the country. Many hospitals and other health clinics are operating at a loss. Appointments for primary and specialty care can be few and far-between. 

Those challenges and others were brought to the forefront by the 144-page report issued in September by the New York-based consulting firm Oliver Wyman.

The report issued a series of recommendations that amounted to a broad redesign of the state’s health care apparatus. Hospitals should consolidate services at different regional locations, the firm recommended, and the state should invest in housing, emergency medical services and internet connectivity in rural areas of the state. 

Now, legislators say they hope to follow through on at least some of those recommendations. 

Lawmakers are already working on legislation to simplify the approval process for new health care facilities, Lyons said in an interview. That process, by which providers must apply to the Green Mountain Care Board for what’s called a certificate of need, is notoriously costly and time-consuming.

“There is a bill,” Lyons said. “I’m working on it with another senator. So we will have that.” 

Lyons said she also expects to examine another problem identified by the consultant’s report: that hospitals’ and clinics’ electronic medical records systems are not always compatible with those used by other providers. 

“I’ll probably put a bill in that gets the discussion started there,” she said. “Nothing that causes an explosion, I hope.”

Lawmakers are also planning to examine the state’s emergency medical services, a subject that was a topic of legislation in the last legislative session, said Rep. Lori Houghton, D-Essex Junction, the outgoing chair of the House Health Care Committee.

Last spring, Gov. Phil Scott signed a bill that bolsters emergency medical services training and increases funding for Medicaid reimbursement for EMS services.  

So some reforms to the state’s emergency medical services system are already “in process,” Houghton said in an interview. But in the upcoming session, the topic is “something we’ll also focus on and see if we can make the transformation go quicker,” she said. 

Houghton, who was recently elected House majority leader, will no longer chair the health care committee come January, due to longstanding practice that prevents majority leaders from being chairs. “But I think I can speak to what is going to be on the table,” she said. 

The speaker of the House will appoint chairs once the legislative session begins in January, so it’s not yet clear who will lead the House’s health care committee. But Houghton mentioned Rep. Alyssa Black, D-Essex, the committee’s ranking member, as a possible successor. 

Black declined to comment Tuesday, saying, “I have no knowledge that I want to pass on.”

The “low-hanging fruit” currently under consideration does not cover many of the recommendations from the consultancy’s report, however. Some of the report’s proposals — such as limiting how much hospitals can bill for care and ending certain procedures at some facilities — are either outside of the Legislature’s purview or would likely entail fierce and lengthy Statehouse battles.

Devon Green, a lobbyist for the Vermont Association of Hospitals and Health Systems, expressed support for many of the proposals from Lyons and Houghton, including investments in emergency medical services and streamlining the certificate of need process. Some Vermont hospitals are already making changes in response to the report, Green said. 

“Hospitals are here doing the work, and we want to work in partnership with other healthcare providers and our state leaders,” she said. 

Lyons, of the Senate health committee, also wants to reexamine how health care is regulated in the state, echoing a bill she backed in the 2024 session that would have shifted some of the oversight powers of the Green Mountain Care Board to the Agency of Human Services.  

“We’ll probably see some discussion about authority, regulatory gaps. You know, who’s in charge of what, where and when?” she said. “I don’t want to go back to the bill that I had put in (this year), but it’ll be a discussion.”

And as the cost of providing and paying for health care has grown increasingly unsustainable, Houghton said, the legislature needs to understand whether earlier health care initiatives, such as mental health urgent care and the Blueprint for Care program, for example, are actually paying off. 

“There’s going to be a concerted effort to call people in and say, this is what we’re doing: We need to really understand how these programs are working, and then fixing them or changing them or scrapping them if they’re not working,” Houghton said. 

But both Houghton and Lyons acknowledged that there is little the Legislature can do that will make care and insurance more affordable for Vermonters in the short term. 

“I don’t have a silver bullet,” Lyons said.