Lucas Farrell is a writer and farmer in Townshend, where he runs Big Picture Farm with his wife, Louisa Conrad. He serves as treasurer of the board of Grace Cottage Family Health & Hospital; these views are his own. His commentary on the New Hampshire Medicaid multiplier appeared in VTDigger on Aug. 25, and his public comment assembling the August hearing record is posted on the Green Mountain Care Board’s website.
TOWNSHEND-Drive south from Townshend on Route 30 this coming January, and you will watch a quarter century of Vermont maternity care disappear in about 50 minutes.
You will first pass Grace Cottage Hospital, which closed its labor unit in 2002. Then, 20 minutes on, you will pass Brattleboro Memorial Hospital, scheduled to deliver its last baby on Dec. 31. Then you keep driving, across the state line, because that is where the nearest delivery room will be: Baystate Franklin Medical Center, in Greenfield, Massachusetts.
If you are in labor on that drive, you will be traveling through time as much as distance: 50 minutes if the road is clear — 24 minutes longer to get to the hospital there than it would take you today to get to Brattleboro. The winter roads are not always clear.
The governor’s office has an answer for this. It cites a drive-time study finding that the closure “will only increase average drive time by 10 minutes” and that everyone stays within an hour of care.
I have spent a month trying to find that study. It has never been published — no methodology, no author, no accounting for winter, no breakdown by town. I have filed a public records request for it, and I will report what comes back.
In the meantime, I built the town-by-town version the state hasn’t released, using Google Maps drive times from every Windham County town to the three nearest hospitals that still deliver babies. Anyone can reproduce it in an afternoon.
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Two of the state’s claims hold up. No town in this county is more than an hour from a delivery room on a clear day, and if you average the whole county, the added drive does land near the number the state gave.
The arithmetic isn’t wrong. It’s measuring the wrong people.
Three of our towns — Londonderry, Stratton, Whitingham — are already closer to Bennington or Greenfield than to Brattleboro. Nothing changes for them; they simply lose a regional choice.
But average their unchanged drives into a county figure, and you have shrunk the loss before you start.The state puts today’s typical drive at 14 minutes. In Windham County it’s about 18. Whoever the state measured lives closer to Brattleboro than we do — which means they weren’t all Vermonters.
Some patients live nearer to Keene or Greenfield already and come here anyway — for the midwives, for the kind of birth a small place can offer. The state’s math scores their shorter future drive as an improvement. It is recording the loss of a choice as a gain.
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An average was never the right question anyway. Obstetric risk does not live in the median; it lives in the tail — in the hemorrhage 45 minutes from a transfusion, in the labor that goes wrong on Route 30 in a snowstorm. You do not dispatch an ambulance to the average mother.
Vermont’s own Perinatal Quality Collaborative treats 30 minutes as the line for obstetric safety, and clinical research ties drives beyond it to more unplanned out-of-hospital births and worse outcomes.
This closure moves the majority of Windham County across that line, and for 14 of the 19 towns losing their nearest hospital, the closest delivery room will be in another state.
Here is the part I did not expect: the towns that lose the most are the ones that had a hospital. Townshend and Newfane each add 24 minutes; Grafton and Windham add three, because they were already past every threshold anyone uses. Their small numbers measure how long they have been stranded.
What this closure does is take the valley and move it out to where the hilltowns have been all along.
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There is a harder problem hiding in plain sight. Roughly 45 percent of Windham County’s births are covered by Medicaid, and the state’s plan leans on Baystate Franklin.
Yet Vermont’s own online provider directory omits Baystate Franklin while listing Cheshire Medical Center in Keene; Baystate’s billing department told Vermont Public it accepts Vermont Medicaid only in emergencies; and under oath in August, BMH’s leaders testified they had received no confirmation from the state that Medicaid patients could deliver there without prior authorization.
The plan is the drive. The drive ends at a door. Nobody has confirmed the door is open.
And understand what crosses that door with each family. The Medicaid check keeps getting written by Vermont — but it is cashed in Massachusetts and New Hampshire, by hospitals whose prices Vermont’s regulator cannot touch. BMH’s own sworn filing says it plainly: these births move “outside of Vermont’s own regulatory system.”
Vermont isn’t just exporting deliveries. It is exporting the jobs that attend them — the nurses are already commuting to Keene — and decades of family medical spending, because healthcare follows the birth. Nobody has run that math, either.
A county that cannot deliver its own babies is a hard sell to the young families whom Vermont says it wants.
“You can’t be born here” is a terrible first line for the brochure.
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The real cause, and the fix: BMH is not closing its birthing center because of bad management, though the management failures were real and infuriating — I have written about them plainly. It is closing because of how the service is paid for.
For an ordinary vaginal delivery, Blue Cross Blue Shield of Vermont pays Brattleboro Memorial $10,575. The lowest payer in the same published file pays $4,764 — almost certainly Vermont Medicaid, whose rate is set by the state.
BMH’s leaders testified that rate hasn’t had an inflationary increase in five or six years and “was woefully inadequate then.” Nearly half the babies born there are paid for at that rate.
This is not a Brattleboro problem.
Northwestern Medical Center in St. Albans — well run, no scandal — told the same regulator the same month that no model exists that lets a Vermont hospital break even on maternity care, and asked for the same fix.
North Country Hospital in Newport calls its unit a loss leader and keeps it anyway. (“We’re not GM — we can’t shut down the Oldsmobile plant.”) Brattleboro is simply the hospital that ran out of other departments to raid.
New Hampshire faced this exact crisis five years ago and fixed it with one paragraph: Hospitals in rural Coös County are paid three times the standard Medicaid rate for labor and delivery. A Republican governor adopted it, the federal government approved it, and that county’s last delivery room is open today.
I made the case for a Vermont version of this policy in VTDigger recently; the short form is that it would cost the state less per year than the one-time crisis grants already handed to BMH.
We aren’t even asking the state to adopt it yet. We are asking it to run the numbers. The state’s own records office confirmed to me that the claims report already exists.
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What you can do before Sept. 15: The Green Mountain Care Board (GMCB) issues its budget orders on Tuesday, Sept. 15 — orders that will either take the closure as settled or put the reimbursement question formally to the state while there is still time.
BMH’s own filing commits it to seek reconsideration of the projected closing of the Birthing Center “should a viable solution present.” The chair who asked BMH why there can’t be “a correction so that we can protect the essential services for the community” writes his final orders that day and steps down at the end of the month.
So the ask is simple: Publish the map. Run the math.
Go to gmcboard.vermont.gov and submit a public comment. It takes 10 minutes, and the board reads what it receives. Tell them what this drive would mean for your family. Name your town and your road.
Ask the GMCB to publish the state’s drive-time analysis by town, to have Vermont Medicaid model the New Hampshire rate against Brattleboro’s actual claims by Oct. 1 and to write into the order what would count as a viable solution. Ask your Selectboard and your legislators for the same.
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Between 2010 and 2022, rural hospitals across the country closed 238 birthing units. Vermont closed none. Copley broke that streak last November; Brattleboro would be the second in 13 months, and nothing in the state’s current answer suggests the sequence ends here.
I have two daughters, ages 6 and 9. They might want to have children in the county where they grew up, and I would like them to have that choice.
Honestly, what I want by then is simpler than a map: my daughters healthy, their babies healthy, should they choose to have them.
Whether that happens in Brattleboro or Greenfield is not really the point. The point is whether they stayed here at all — and whether they stayed because Vermont kept making the small, unglamorous decisions that let people build a life here.
New Hampshire made one of those five years ago:It made no headlines. Coös County still has a delivery room. Those decisions rarely announce themselves.
This one is being made in September, and it looks like a spreadsheet.
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