The Community Health Centers of Burlington recorded 165,000 patient visits last year, 35,000 more than five years ago. One out of every 10 visits now requires translation services, and hundreds of checkups are performed not in a doctor's office but on the streets, in the woods and wherever else backpack-carrying providers can find patients of an increasingly needed homeless outreach program. CEO Jeffrey McKee and his staff have never worked harder. Yet the center is quickly going broke, unable to cover growing expenses — starting with the cost of its own workers' health care. The Chittenden County provider is projecting a $2 million budget gap largely driven by rising health insurance costs. Next year, it will pay 55 percent more for plans than in 2022. "We're losing about $300,000 a month," McKee said at a meeting with state officials and local health care leaders last month. "An organization our size cannot sustain that." Similar conclusions are being reached all across Vermont — in hushed tones at dinner tables, behind closed doors at local businesses and during budget meetings at public schools. On this, there is no debate: Health care has become unaffordable and grows more so each year. The monthly cost of a typical plan on the state's insurance marketplace has doubled over the past six years — from $474 to $948 — and ranks among the country's most expensive. Individuals qualify for subsidies, but employers do not. They must absorb the hikes or pass the costs on to their workers. Rising costs are leading more healthy people to consider ditching insurance entirely, a dicey proposition that could deepen Vermont's problem by further shrinking the risk pool and leaving it with a larger proportion of people who need costly medical services. State regulators have responded by targeting the main driver of insurance premium hikes: hospital costs. But efforts to limit hospitals' budget growth have jeopardized their futures. Nine of the state's 14 hospitals, all nonprofits, lost money last year, and some have less than half of the minimum recommended cash reserves. A law passed in 2022 known as Act 167 commissioned a report on Vermont's health care system and how it can be made more sustainable. Released this fall, the report made a dire prediction: Vermont's hospital system could need massive new cash injections merely to maintain the status quo. "There is no hospital in Vermont…