Column: Does the Green Mountain Care Board really care?

George Tyler is a columnist for the Essex Reporter. A resident of Essex Junction, Tyler is a former journalist, village trustee and city councilor.

"I have a bad feeling about this" is a catch phrase that runs through the Star Wars franchise, first voiced by Luke Skywalker when he spots the Death Star from the cockpit of the Millenium Falcon.

At the risk of making light of a serious subject, the phrase sums up my thoughts after sorting through the acronym-dense and conceptually boggling landscape of Vermont's current health care reform efforts.

I was trying to understand why the University of Vermont Health Network had recently made deep cuts in its outpatient services. If you're not up on local news, UVMHN said it made the cuts to comply with a drastic reduction in its 2025 operating budget imposed on it by the Green Mountain Care Board, a semi-autonomous state regulatory body with a whole lot of authority and zero elected accountability, created ten years ago by the Vermont Legislature during the Shumlin administration.

The Legislature intended GMCB to use its budget-cutting powers to rein in health costs while, at the same time, improving accessibility and quality. It was supposed to accomplish this seemingly contradictory mission through the thoughtful application of the euphemistically-rich but detail-poor magic of health care reform ideology: the GMCB would strive for sustainability, equity, improved communication, and accountability, with lots of data-driven, patient-centric, consumer-friendly transparency.

In Dickensian terms, there were great expectations.

Ten years later, Vermont's health insurance costs have ballooned to some of the highest in the country, and most of its hospitals are in serious financial trouble. The only success the GMCB can reasonably point to is that the rate of increase in hospital budgets is slightly less than before it was created. But even this claim is mathematically sketchy.

More troubling than the GMCB's systemic failure, particularly for the Essex community, is its increasingly nasty attitude towards UVMHN.

When the GMCB slashed UVMHN's 2025 budget by a whopping $122 million, they darn well knew they were forcing UVM to make gut-wrenching choices that were bound to harm some of its patient base and hobble its strategic planning. It was predictable that UVM would push back publicly and even threaten legal action claiming that the GMCB was outside its bounds and hadn't allowed UVM due process to negotiate.

Regardless of how much UVMHN might bluster and threaten, the GMCB ultimately had the upper hand because of its state mandate, so all it really had to do at that point was allow UVMHN to vent its understandable frustration and ride out the storm.

Instead, the GMCB issued a press release that doubled down on its criticism of UVMHN, and even politicized the dispute by adding that UVMHN had done a "disservice to the community and the many hard-working employees of the hospital."

Those unfamiliar with local and state government might not appreciate how out of line this was. It showed a complete lack of empathy for the financial damage it had inflicted on UVMHN, justified or not, and revealed an arrogant and even bullying attitude from a board that itself has little to show for the tens of millions in state funding it's received since its inception ten years ago. This is what gave me the "I just spotted the death star" bad feeling.

Like other academic medical centers, UVMHN is much more than a health care provider. It channels high level medical expertise into the state's health care system through its affiliation with a medical school, a nursing school, and a university research community, all of which also generate hundreds of millions of dollars for the state's economy. Many Essex City and Town residents are employed by UVMHN and have a stake in its success.

UVMHN is not the bad guy here and hasn't been given a fair shake. In fact, as the provider of roughly 60% of Vermont's health care needs through their affiliated network, UVMHN might actually know a thing or two about health care delivery that the Green Mountain Care Board, which provides actual health care for no one, doesn't.

I know the legislators who are struggling to control Vermont's health care costs are excellent people who've nobly taken on an impossible problem. Vermont lacks the demographic and economic scale required to sustain its current health care system. There's no easy way out.

But I urge them to look beyond the GMCB's happy-graphic power point presentations in the polite confines of statehouse meeting rooms and realize that this is a board that's grown imperious and condescending to the health care professionals it's supposed to be working with.

Its public bullying of Vermont's struggling academic medical center, which is responsible for hundreds of thousands of patients, as well as a major piece of the state's economy, is unacceptable.

At the very least, the legislature needs to intervene before this thing goes to court and remind the GMCB of the Hippocratic oath: First do no harm.

Columns are opinion pieces regularly contributed by a select group of writers. Columns reflect the opinions of the writer and do not represent the views of the Essex Reporter.