RICHMOND, Vt. — On a warm autumn morning, Roger Brown walked through a grove of towering trees whose sap fuels his maple syrup business. He was checking for damage after recent flooding.

But these days, his workers’ health worries him more than his trees’. This story also ran on . It can be .

The cost of Slopeside Syrup’s employee health insurance premiums spiked 24% this year. Next year it will rise 14%. The jumps mean less money to pay workers, and expensive insurance coverage that doesn’t ensure employees can get care, Brown said.

“Vermont is seen as the most progressive state, so how is health care here so screwed up?” Vermont consistently ranks among the healthiest states, and its unemployment and uninsured rates are among the lowest. Yet Vermonters for individual health coverage, and state reports show its providers and insurers are in financial trouble. Nine of the state’s 14 hospitals , and the state’s largest insurer is struggling to remain solvent.

for care have become increasingly common, according to state reports and interviews with residents and industry officials. Rising health costs are a problem across the country, but Vermont’s situation surprises health experts because virtually all its residents have insurance and the state regulates care and coverage prices. For more than 15 years, federal and state policymakers have focused on increasing the number of people insured, which they expected would shore up hospital finances and make care m.