The Impossible Dream: Vermont Promises Universal Primary Care Before Answering Who Pays
Stephanie Mack calls for honest accounting, realistic cost estimates, and a workable plan before Vermont commits to another expensive healthcare experiment.
ESSEX, VT — Universal primary care has become a centerpiece of Vermont's 2026 election season, with promises that every resident could receive primary and preventive healthcare without copays, deductibles, or insurance barriers. It is an appealing vision in a state where families and small businesses are already struggling with some of the nation's highest healthcare costs. But according to Stephanie Mack, Republican candidate for the Vermont House in Chittenden-24, the promises are getting ahead of the numbers.
"Everyone deserves access to quality healthcare, but promising something is free doesn't make it free," Mack said. "Before Vermont commits hundreds of millions of dollars to another government program, we need to know exactly what we're buying, how it will work, and who is going to pay for it."
Democratic gubernatorial candidate Amanda Janoo has proposed a publicly funded universal primary care system, estimating its annual cost at approximately $320 million. The proposal relies on higher income taxes for wealthy Vermonters, with advocates arguing that preventive care would reduce costly hospitalizations and emergency room visits. But that estimate remains preliminary, and the projected savings have yet to be established through a comprehensive, independent actuarial analysis.
Vermont Has Studied This Before
The financial questions are not new. In 2015, Vermont commissioned an actuarial analysis of universal primary care. The resulting estimates, incorporated into a November 2016 state report, projected approximately $282 million in annual medical claims for a program without patient cost-sharing in 2017. After accounting for existing Medicaid spending, approximately $175 million in claims would have required other public financing, before additional administrative and implementation costs.
Those are historical estimates, not a current price tag. Nevertheless, they demonstrate that Vermont has understood the financial magnitude of this proposal for more than a decade.
The 2016 report also contained a finding that deserves renewed public attention: its review found no peer-reviewed studies demonstrating savings directly attributable to universal access to primary care. The report did recognize that stronger primary care systems can improve health outcomes and reduce certain medical expenses. But better preventive care and a self-financing statewide program are not the same thing.
"Vermonters have heard promises of healthcare savings before," Mack said. "I want to see those savings demonstrated with actual numbers, not simply assumed because the proposal sounds good."
Federal Law Creates Another Complication
Vermont must also confront limitations imposed by the federal Employee Retirement Income Security Act, known as ERISA. Many large private employers, including healthcare organizations, operate self-insured employee health plans governed by federal law. Vermont cannot simply require those plans to surrender their existing coverage arrangements and become part of a single state-administered insurance pool.
In 2016, the U.S. Supreme Court ruled against Vermont in Gobeille v. Liberty Mutual Insurance Co., finding that federal law prevented the state from imposing certain health insurance reporting requirements on ERISA-covered plans.
That ruling did not prohibit Vermont from creating a publicly funded primary care program. It did, however, establish important limits on the state's ability to regulate private employer health plans.
A new system would therefore need to explain how public benefits would coexist with existing employer-sponsored insurance, whether premiums would actually decrease, and how overlapping coverage and payments would be handled.
The Legislature Is Still Studying the Answers
Vermont's Act 173, signed into law in June 2026, expresses the Legislature's intention to pursue universal primary care while directing state agencies to examine payment methods, existing primary care spending, and potential financing arrangements.
Several significant reports are not due until January 15, 2027. In other words, important details about how Vermont might implement and finance its program are still being developed even as voters hear expansive promises about what it
will deliver.
"Healthcare reform should begin with understanding where the money goes today," Mack said. "Are we reducing the cost of providing care, or are we simply moving the bills from insurance companies to taxpayers? If families are going to pay higher taxes but still need expensive insurance for hospital care, specialists, and prescriptions, we need to know whether they will actually be better off."
Mack argues that Vermont should concentrate on practical, measurable improvements, including greater transparency in healthcare spending, reducing unnecessary administrative expenses, supporting local primary care providers, and identifying reforms that lower costs without creating additional unfunded obligations.
"Vermont families cannot afford another expensive experiment built on promises that have not been tested," Mack concluded. "We need better healthcare, but we also need responsible government. Before Montpelier spends more, Vermont taxpayers deserve answers."
Comments