State fiscal officers push back on health care cost pressures

Pieciak said the end of Affordable Care Act subsidies has already pushed more than 2,500 Vermonters to go without insurance.

As federal health policy shifts continue to ripple through states, Vermont Treasurer Mike Pieciak and a group of state fiscal officers said they are trying to blunt the impact on families facing higher medical costs and reduced coverage options.

The officials spoke with reporters on Thursday during a national briefing organized by For the Long Term, a group that says it is working on plans to shield households from what it described as rising affordability problems tied to Trump administration actions.

Pieciak said Vermont cannot fully offset the changes on its own while federal policy moves in the opposite direction, and he argued that residents deserve stronger support from Washington. Pieciak said the end of Affordable Care Act subsidies has already pushed more than 2,500 Vermonters to go without insurance through Vermont's public exchange. He also pointed to tightened Medicaid rules that removed coverage from noncitizens and said additional changes expected in 2027 could lead to roughly 30,000 more people losing Medicaid coverage in Vermont.

He said health care costs have become one of the biggest concerns in the state, with residents paying more each year even as appointment delays grow, travel distances for care increase and access becomes less reliable in rural areas. Pieciak added that Vermont's aging population makes it harder to attract and keep younger workers in the health care system.

Housing shortages are also making the problem worse, he said, because hospitals and clinics struggle to recruit staff. That shortage often forces providers to rely on traveling nurses and other temporary workers, who tend to cost more and can add to overall medical expenses.

Pieciak highlighted steps his office has taken to ease the burden, including a partnership launched last year with a nonprofit that will erase as much as $100 million in medical debt after a one-time $1 million appropriation. He said people carrying medical debt are less likely to seek care when they need it, which can worsen health outcomes and eventually raise costs for everyone in the system.

This year, his office also worked to bring Vermont into a multistate public partnership offering a pharmacy discount card that is expected to save patients thousands of dollars annually.

Minnesota State Auditor Judy Blaha said the federal government, including Trump and Congress, should undo the damage. She also called for broader cooperation among states.

Illinois State Treasurer Mike Frerichs said states cannot replace federal programs, but they can still help people who have fallen through the cracks. He said Illinois is working to support safety net hospitals and reduce medical debt while also requiring financially stressed hospitals to disclose more about their finances and prepare contingency plans.

Frerichs said Illinois is investing about $60 million more in federally qualified health centers and free clinics to help uninsured residents. He described medical debt as a major burden that can drain savings and damage credit, and said health care cuts at the federal level make it harder for families to stay afloat.