Vermont's hospitals are in trouble. A new analysis found that the state's hospitals would need as much as $3 billion in subsidies — from commercial insurance increases or taxpayers — to remain solvent over the next five years, if immediate steps aren't taken. That figure comes from a 142-page report outlining a plan to radically transform the state's health care delivery system to bring down costs while continuing to provide access to care. The report was mandated by statute and put together by the consulting firm Oliver Wyman, whose team conducted a series of meetings with thousands of patients, health care workers, hospital leaders and advocates over the past year. Some of the headwinds facing the state's costly health care system: Commercial insurance rates are some of the highest in the country, and have increased by double digits for three years in a row, far outpacing the national average. Most of the state's 14 hospitals are operating at a loss, and those losses are expected to worsen in the coming years. Vermont's population is aging and shrinking, which will put further strain on the health care system and workforce. Patients face long wait times for primary care and specialty care and have inadequate access to community based services, leading to expensive, sometimes unnecessary hospital visits. Low-income households in rural areas face some of the greatest barriers to accessing care, stemming from a lack of affordable housing, transportation, and culturally competent care.