Vermont earns a B+ and ranks 11th of 51 states. For 647,464 people spread across 14 counties and a lot of mountain roads, that's a genuine achievement. The death rate sits at 7,660 per 100,000, more than a quarter below the national average. Vermonters weigh less than the national norm, move more, smoke less, and hold health insurance at some of the highest rates in the country. If you came looking for a success story, the scorecard delivers one.
Two numbers don't fit, though. Vermont's depression rate is 27.2%, above the national average, in a state that otherwise dominates nearly every physical health measure. And Vermont's providers are opting out of Medicare at a rate worse than every state but one. Not Mississippi. Not Alabama. Vermont, ranked 11th, where more than 200 doctors have formally walked away from the public insurance program anchoring the system this state spent decades building.
The B+ is real. So is the tension underneath it.
The ReportCard comparison tells a consistent story. Vermont's obesity rate sits at 30.4% against a national 37.5%. That gap doesn't stay in the obesity column. It cascades into cardiovascular outcomes: high blood pressure affects 30.5% of Vermont adults versus 36.1% nationally; diagnosed diabetes touches just 8.4% of the population against 12.4% nationally. Lower weight, less heart disease, less diabetes. The connections are direct.
Smoking stands at 12.4%, well below the national 16.1%. Physical inactivity runs at 19.8%, among the four lowest nationally. The winters are brutal and Vermonters still move. That behavioral advantage shows up across almost every downstream health metric in the state.
The uninsured rate is 6.5%, one of the three lowest in the country. Compare that to Texas, where 20.7% of adults go without coverage. That's nearly one in five Texans choosing between the emergency room and ignoring symptoms. Insurance is the gateway to early diagnosis, prescription access, and preventive screenings. Vermont's near-universal coverage isn't just a statistic. It's the structural foundation that explains most of what follows.
Child poverty runs roughly 12.1% against a national average of 19.4%, placing Vermont among the five lowest nationally. Children who grow up in poverty accumulate health disadvantages that follow them for life: more asthma, more obesity, worse mental health outcomes. Vermont's lower poverty rate is a long-term investment that shows up in the numbers decades later. Median household income of $73,440 reinforces the picture.
Then there's depression. 27.2% of Vermont adults report a diagnosis, compared to 23.5% nationally. More than one in four. In a state with top-tier physical health numbers, it's the indicator that demands explanation, not just acknowledgment.
Vermont's divergence from national CDC averages has a clear shape on the deviations chart: substantially better on physical health measures, measurably worse on mental and behavioral ones. The biggest positive gap is dental visits. 67.6% of adults visited a dentist in the past year, nearly 10 points above the national average of 57.8%, among the five best states on this measure. That's not just a dental story. Dental visits function as a proxy for healthcare engagement broadly. Vermonters who go to the dentist also tend to get their cholesterol checked and their cancer screenings done.
Physical inactivity runs nearly 8 points better than average. Obesity is 7 points better. Overall disability rates are about 7 points lower. Short sleep, high blood pressure, high cholesterol, uninsured rates: Vermont outperforms nationally on nearly every physical health measure, consistently by 5 to 7 points. The pattern is unmistakable.
The pattern breaks on mental health and behavior. Depression at 27.2% runs nearly 4 points above the national average. Excessive drinking at 17.5% is above the national rate of 16.7%, and Vermont's drinking rate is worse than about a third of states. Mississippi, the least healthy state overall, has an excessive drinking rate of just 13.4%. Vermont's combination of rural isolation, long winters, and a binge-drinking culture among college-educated young adults creates behavioral pressures that physical fitness doesn't resolve.
Colorectal cancer screening at 65.3% and mammography use above national averages confirm Vermont's preventive care culture is strong. The deviations chart for this state is essentially a story about a population that takes excellent care of its body and struggles with what's happening in its mind.
Vermont has 13,943 total providers across 101 specialties. The AccessGrid tells a more complicated story than that number suggests. Fewer than 40% of those providers are enrolled in CMS, meaning the majority don't participate in Medicare billing at all. Of the 5,190 CMS-enrolled providers, 4,744 accept Medicare patients. 1,009 offer telehealth. In a rural state with long winters and mountain roads, that isn't a convenience feature. It's how some people get care at all.
The top provider type in Vermont is mental health counselors, with 1,792 practicing statewide. Clinical social workers add 1,371. Clinical psychologists contribute another 676. Vermont has built a behavioral health infrastructure that dwarfs its primary care physician base in absolute terms, reflecting decades of intentional state investment. And yet 12 mental health shortage areas still affect nearly 159,000 people. That isn't a funding failure. When more than one in four adults is living with depression, no realistic staffing level closes the gap entirely.
So where does that leave the patient in Canaan who needs a counseling appointment? Primary care shortage areas number 15, touching nearly 193,000 residents, approaching 30% of the state's population. Dental shortage areas cover 14 geographic zones with 201,205 affected residents. Family practice providers number just 487 statewide. Internal medicine adds 402. The totals look manageable for a state this size until you map provider locations against patient addresses and the roads between them.
Vermont's 17 hospitals serve a dispersed population across mountainous terrain. The University of Vermont Medical Center in Burlington is the anchor, a Level I trauma center with genuine academic and specialty capacity. Beyond Burlington, the state relies on critical access hospitals in communities like St. Johnsbury, Newport, and Morrisville that preserve local emergency care but can't replicate a larger system's specialty depth. The 34 nursing homes, 9 home health agencies, and 10 hospice providers complete a long-term care network that is thin by most measures.
Vermont's ER utilization runs at 640.3 visits per 1,000 Medicare beneficiaries. That's a higher rate than Arizona, which sees just 533.9 visits per 1,000, despite Arizona ranking 50th overall on health outcomes. For a state with Vermont's physical health profile, this level of emergency reliance has one explanation: when primary care access erodes in rural areas, people defer until they can't, and then they show up at the emergency room. The shortage area numbers aren't abstract. They're the upstream cause of this downstream cost.
A median household income of $73,440 and an uninsured rate of 6.5% put most Vermonters in a better financial position than the national average when it comes to healthcare costs. The insurer network has reasonable diversity. BCBS Vermont leads with 6,568 participating providers, followed by Cigna at 6,008, Medicare at 5,190, and UnitedHealthcare at 3,691. BCBS Vermont's local footprint provides some counterweight to the national carriers.
Total Medicare prescription spending reaches $838 million across 5.1 million claims from 2,654 prescribers. The top drug by claims is atorvastatin calcium, a cholesterol statin, with 275,427 claims at $4.7 million. Lisinopril for blood pressure and levothyroxine sodium for thyroid disease follow closely. Heart, thyroid, and cholesterol: these are the drugs of an aging northern population managing chronic conditions well. Their volume is exactly what Vermont's demographics predict.
The financial outlier is apixaban, a blood thinner for atrial fibrillation and stroke prevention. At 108,138 claims, it generates $99.9 million in costs, nearly 12% of the state's entire Medicare drug spend from a single medication. That concentration says something direct about Vermont's age profile and the expensive, necessary work of keeping its oldest residents out of the hospital with strokes. Gabapentin, at 127,015 claims, carries a dual signal: it treats nerve pain, but it's also a tool in substance use treatment protocols, and its volume here reflects both realities.
Vermont's SocialRadarChart shows relative strength on food security and income, and clear gaps on transportation and housing. The stronger measures are real protections. Income inequality is moderate. Child poverty is among the lowest in the country. These structural advantages explain much of the gap between Vermont and states with similar rural profiles but worse health statistics.
But geography creates its own deprivation. Burlington, with about 45,000 people, is the largest city. There is no second city. For roughly a third of the state's population, seeing a specialist means a long drive on mountain roads, often in conditions that make that drive genuinely difficult. That isn't an inconvenience. It's a structural barrier that no amount of provider recruitment fully resolves.
Housing pressure has intensified sharply in recent years. The pandemic-era migration of remote workers from Boston and New York drove costs up in a state with limited supply and slow permitting. The people most affected are the ones Vermont's health system depends on: home health aides, nursing home workers, lower-income families who can no longer afford to live near the communities they serve. Housing instability is a proven upstream driver of poor health outcomes, and Vermont's housing market has moved against its most vulnerable residents.
201,205 people live in designated dental shortage areas. 192,841 live in primary care shortage areas. These aren't shortage areas because Vermont lacks providers. They're shortage areas because providers are in Burlington and patients are in Canaan and Irasburg. Without transit infrastructure connecting rural communities to care, distance becomes a clinical barrier as real as any gap in the provider directory.
Pharmaceutical industry payments to Vermont providers total $1,225,514, reaching 471 physicians from 233 companies. The payment breakdown shows what's actually happening here. Consulting fees represent the largest category: $415,997 across 119 payments. Royalty and license fees account for $374,706 across just 10 transactions, pointing to a handful of academic researchers at UVM with substantive industry relationships. Speaking and faculty compensation adds $176,818. Travel and lodging runs $138,940 across 356 payments, the most widespread category by transaction count. Food and beverage totals just $63,445 across 1,533 items, averaging about $41 each.
These are modest numbers consistent with a small academic medical community. Vermont's pharmaceutical payment profile looks like a research institution doing legitimate work, not a state where industry has meaningful influence over prescribing patterns.
There are currently 14 providers actively excluded from federal health programs in Vermont, roughly 1.0 per 1,000 enrolled providers. These are live exclusions for fraud, sanctions, or license actions. The number is proportionate for a state this size.
The Medicare opt-out numbers are a different matter. 236 Vermont providers have formally opted out of Medicare, a rate of 16.9 per 1,000 enrolled, worse than all but one state in the country. Kentucky, ranked 44th overall on health outcomes, has an opt-out rate of just 2.7 per 1,000. That gap isn't small. It isn't a rounding artifact. It's a structural feature of Vermont's health policy environment.
Vermont's Medicare acceptance rate of 91.4% ranks worse than all but two other states nationally. Even Mississippi, the least healthy state overall, maintains a higher Medicare acceptance rate. Vermont's all-payer model and global budgeting reforms changed provider payment structures in ways that have made Medicare participation less financially attractive for many providers, particularly specialists.
Who suffers most? Medicare beneficiaries: disproportionately older, often rural, often on fixed incomes. The very people Vermont's progressive health system was designed to protect. A state built its identity on health equity and simultaneously created conditions where rational providers find it financially preferable to turn away its most vulnerable patients. That's an incentive problem. Incentive problems have solutions. Vermont fixed its insurance coverage numbers through deliberate policy. It can fix this the same way. Until it does, the B+ papers over an access problem that falls hardest on the people least able to work around it.
Vermont received 21 NIH grants totaling just over $6.3 million, worse than more than 40 states nationally. California, ranked 16th overall, received $907 million. The disparity is structural: large academic medical centers generate large research portfolios, and Vermont has one research-active institution of real scale, the University of Vermont Medical Center.
Active clinical trials number 2,423, worse than all but three states nationally. Texas, ranked 36th overall, a less healthy state by nearly every measure, runs 40,768 active trials. Research volume follows population and academic infrastructure. Vermont doesn't compete on those dimensions, and the research grid shows it clearly.
What Vermont can offer is focus. UVM has developed genuine expertise in substance use disorder treatment, rural health delivery, and mental health care, the precise problems this state actually faces. The NIH grant total is a constraint, not a verdict on quality. But the thin research infrastructure relative to Vermont's overall health standing represents a real gap. The state knows what ails it. It has limited institutional capacity to generate the evidence base for fixing it.
Vermont's 14 counties reveal a state split between the prosperous Champlain Valley and a struggling interior. The county dot plot makes that split visible. Chittenden County, home to Burlington and UVM, anchors the healthy end: a death rate of 5,480, obesity at just 20%, and a median income of $96,142. Those numbers are competitive with the healthiest counties in the country.
At the other end sits Essex County in the Northeast Kingdom: a death rate of 9,787 and a median income of just $58,359. The internal mortality gap is a ratio of 1.8x between Vermont's best and worst county. Rutland County posts a death rate of 9,134 with income at $62,634. Orleans County runs at 8,961 deaths per 100,000 with a median income of $59,906.
These aren't statistical outliers. They're communities with specific histories: Rutland's opioid crisis, Orleans County's isolation, the slow economic attrition of the Northeast Kingdom across three decades. The healthiest counties form a belt along the western edge near Lake Champlain. Addison County posts a death rate of 5,658 and Grand Isle County runs at 6,017, both with incomes above $82,000.
The pattern maps precisely onto wealth, proximity to Burlington's health infrastructure, and access to the regional economy. The distance between Chittenden County and Essex County isn't just geography. It's decades of life expectancy.
Vermont's B+ is the product of real decisions: near-universal insurance, low child poverty, a genuine preventive care culture, decades of investment in behavioral health infrastructure. These are things Vermont chose to do, and the health statistics confirm they worked. A death rate 26% below the national average isn't luck. That's thousands of lives that exist because this state decided to build a health system rather than just a market.
The remaining failures share a common feature: they can't be solved from Burlington. Depression follows the social geography of rural depopulation, long winters, and communities still absorbing the damage of the opioid era. You can staff mental health clinics in every county. You can't reverse the conditions that fill them from a clinic.
The Medicare opt-out problem is different in character. That one can be fixed. Vermont solved its insurance coverage numbers through deliberate policy intervention. It can redesign provider payment incentives the same way, if it decides to. The B+ says it hasn't decided to yet. The people waiting on that decision are the oldest, poorest, and most rural Vermonters, the exact population this state told itself it was building its health system to serve.