• Luke Awtry
• Cindy Massie

Cindy Massie was thrilled when she landed a cleaning job last September at the University of Vermont Medical Center. That same month, the new support staff union and the hospital agreed to a contract that boosted her pay to $22.08 an hour — close to $45,000 annually, the most she's ever earned.

Massie, a 45-year-old single mother who lives in Milton, has since bought new clothes for her children — ages 18, 15 and 8 — and has filled her grocery cart without dreading the cost. She's even taken her four cats to the vet for the first time.

"We were slowly coming out of that dark place," she said.

But Massie's windfall had an unexpected consequence: She earns too much money now to qualify for Medicaid, so she'll be booted off the government-subsidized insurance plan at the end of August and will seek insurance through her employer.

She has signed up for one of the cheapest health benefit plans that the hospital offers, at $130 a month, she said. But it comes with a large deductible and copays, and Massie has health conditions that require her to regularly see doctors and receive treatment.

She fears she will be forced to choose between feeding her family and taking care of herself.

"I'm so terrified of falling back into that struggle," she said.

As the costs of medical care and health insurance continue to increase at an alarming rate, even those who work at Vermont's largest hospital are struggling to afford to go to the doctor. The support staff union at the UVM Medical Center says some of its members have put off seeking care while others have racked up medical debt — including to the hospital itself. The union wants the hospital to shoulder more of this burden.

The hospital did not make any representatives available for an interview for this story. But in a statement, it maintained that its benefits are competitive and suggested that reducing costs for employees would only force all of its patients and their insurers to pay more.

"We acknowledge that health care is expensive, and our team works hard to offer the best benefits to our staff possible, while remembering that the cost of medical equipment, services and prescription drugs has to come from somewhere," the hospital said.

The situation is a bleak reminder of how deep Vermont's health care cost problems run.

"If this isn't an indicator that our system is broken, I don't know what is," said Mike Fisher, Vermont's health care advocate.

A rapid growth in hospital budgets over the past five years has helped drive up the cost of private insurance premiums by more than half, according to state regulators. Yet more increases are coming: The Green Mountain Care Board approved a request from the state's largest insurer this month to raise premiums by up to 23 percent, the third straight year of double-digit hikes for Blue Cross Blue Shield of Vermont.

The company said it needs the higher rates to avoid financial insolvency. Leaders of the many businesses and nonprofits that rely on group plans say the relentless, steep increases are threatening their survival.

Affordability was the driving force behind the recent effort to organize the UVM Medical Center support staff. Formed in 2023, the union now represents 2,200 of the hospital's lowest-paid workers, including nursing assistants, clerical workers, patient attendants, custodians and food service workers. The diverse workforce includes many immigrants and refugees.

Heather Bauman, a phlebotomist on the union's negotiating team, approached last year's contract talks determined to help her colleagues better afford to live in expensive Chittenden County. That meant not only pursuing higher wages but also finding a way to reduce their health care costs. Like other hospital employees, support staff workers must pay 20 percent of their insurance premiums.

"You don't need an advanced degree to know that that's a regressive system," Bauman said. "The people who earn the least are paying the most of their income."

The union proposed changing that to a sliding-scale system that would require the hospital to cover more of the tab. Those earning $20 an hour would have paid only 3 percent of their premiums, while employees making $43 an hour would have covered closer to 20 percent.

As the negotiations dragged on last summer, the hospital came around to the union's wage proposals. It agreed to a $20 wage floor and to increase pay by an average of 22 percent over the first year, with an additional 10 percent raise over the following two years. But union reps say they gained little traction on the health care costs.

In the final week of negotiations, Bauman and other union members marched on the hospital's administrative offices to demand that president and chief operating officer Stephen Leffler address their proposal. Leffler told the group that any changes to their plans would require approval from the hospital's parent company, the UVM Health Network. There was not enough time to consider their proposals, he told the group.

The next day, Leffler attended the final negotiating session — a 12-hour affair that went until 5 a.m. — and promised to do what he could to "protect the most vulnerable," according to Bauman.

The union made a few last-minute proposals, Bauman said. It asked, for instance, for the hospital to cover the premiums of anyone who would no longer qualify for Medicaid. It requested that the hospital promise not to pursue employees' medical debt or, at least, not to send those debts to a collection agency.

But the hospital shot down the requests. Instead, it agreed to set up a committee to review what could be done.

Bauman had mixed feelings as she walked out to her car that morning.

"I cried because I was disappointed," Bauman said. "I was really scared and sad about the health care situation."

She knew the wage increases would have a "life-changing" impact for many employees. But she also knew that some people would wind up in the position Massie now finds herself in: thrust off the benefits cliff without a parachute.

When Massie's government benefits were up for renewal this summer, her increased pay was factored in. Overnight, the portion of rent she was obligated to pay for her Section 8 apartment jumped from $700 to $1,230 a month. Her food stamps were cut off.

Bauman, who is now the union's president, heard nothing further about the promised committee during the final months of 2023. It wasn't until this January, when she and fellow union members spoke at a press conference in favor of proposed legislation to expand Medicaid coverage, that the committee scheduled its first meeting, she said.

Committee members have met five times since then but have made little progress on a new proposal, with the hospital maintaining that its health care plans are affordable.

The union disagrees, pointing to a recent internal survey that showed roughly half of its members were only "somewhat satisfied" with the affordability of their insurance plans, and one in four were "not at all" satisfied.

Perhaps most notable, of the close to 1,000 respondents, 33 percent reported having medical debt, and most owed money to the UVM Health Network. That includes Rick, a front desk attendant at the Burlington hospital who spoke to Seven Days but asked the paper to withhold his last name because of his debt.

Rick worked in retail for two decades but made a career switch last year after an undetected infection left him in a weeklong coma and forced him to undergo months of rehab. The excellent care he received at the hospital convinced him that he wanted to work somewhere where he could make a difference in people's lives, he said.

He's now on the hospital's health insurance plan, which he said requires him to cover copays for certain medications and doctor visits. He said he's also had to foot the bill for some expensive tests that his insurance wouldn't cover.

Rick estimates that he's added $50,000 to his already sizable medical debts since joining the hospital. Some of that has already been sent to debt collectors, he said, who now regularly text his phone.

"I've just become numb to it at this point," he said of his mounting debts. "I mean, what else am I to do? Sit home and cry?"

The hospital said it could not easily confirm how many, if any, of its employees owe medical debt or whether any had been sent to collection agencies.

In an emailed statement, hospital spokesperson Annie Mackin said its employees are eligible for the same financial assistance programs offered to all patients. That includes monthly payment plans, as well as the chance to apply to have some or all of their debts forgiven.

The hospital has a partnership with United Way to connect employees with "resource coordinators" who can help them apply for assistance, including Medicaid, if they qualify.

"We do need to do more to help employees understand available assistance and connect them with resources, and plans are in motion to create a guide that does that," Mackin wrote.

In the meantime, Massie is bracing for her first health insurance bill.

She's already grappling with car repairs and frequent trips to Brattleboro to visit her son, who's receiving medical treatment there.

The $130 monthly insurance premiums, she said, will be consequential. "That's five meals we might not be able to get from the store," she said. "That's two or three weeks of gas."

She tries to avoid thinking about money while she's at work because she knows that the hospital's patients have their own worries; she likes to think that one of her best assets is her positivity.

"I'm not just a cleaner," she said. "I like to go in their rooms, meet them, bring them life and energy."

It can be hard to keep that up, though, when she's worried about getting sick herself — and obsessively checking her bank balance.