No more health insurance rate hikes, picketers tell Green Mountain Care Board

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After hearing hours of sometimes-emotional testimony, Green Mountain Care Board members must decide whether two insurers - Blue Cross and Blue Shield of Vermont and MVP Health Care - can enact significant rate hikes in 2019.

They'll have a lot to think about over the next few weeks.

Two days of public hearings on proposed rate increases wrapped up Tuesday evening with an outpouring of concern about health care costs. At Montpelier City Hall, a steady stream of speakers told tales of illness, big bills and endless worry.

Eliza Hale of Washington said the recent birth of her daughter made her think about the future.

"At the rate that the (insurance) rate hikes are going, I don't think my daughter will ever have a chance to have a child because of how much it costs," she said.

The board regulates insurance rates as part of its mandate to control the growth of health care costs in Vermont. A list of pending reviews and recent decisions is available at the board's insurance review webpage.

The cases currently attracting the most attention are Blue Cross' and MVP's plans to raise insurance premiums for plans on Vermont Health Connect, the state's health care exchange. The insurers have cited factors like increased health care utilization and higher drug costs as reasons for the hikes.

MVP has proposed an average increase of 10.9 percent, while Blue Cross' most recent proposal is a hike of 9.6 percent. Those numbers, however, are not an accurate representation of the prices most Vermonters would pay.

That's because the Vermont Legislature, in an effort to preserve access to federal health care subsidies, made a change earlier this year that artificially inflated the price of silver-level plans on Vermont Health Connect.

So, taking that change into account, a more accurate representation of the proposed rate hikes is 6.9 percent for Blue Cross and 6.4 percent for MVP.

That's still too high for those who say they already can't afford decent health care.

Before Tuesday evening's care board hearing, the Vermont Workers' Center staged an informational picket outside Montpelier City Hall. Wearing red and carrying signs, demonstrators chanted, "No more rate hikes - health care is a human right."

Green Mountain Care Board officials have touted their annual reductions in insurers' rate requests - a fact recently lamented by Blue Cross. But as he took a brief break from marching in the Workers' Center protest, Tev Kelman said the board hasn't done enough to move Vermont "toward a system that treats health care as a public good rather than a commodity."

"Despite holding these public hearings, it doesn't feel like they're really hearing the public," Kelman said.

Inside the hearing, Nancy Detra of Guilford told board members about her struggles with depression and the cost of treatment. She currently has Medicare and supplemental Blue Cross coverage, but Detra said she pays $338 monthly for health insurance and another $600 per month for treatments.

If rates go up, Detra said, "I can almost guarantee I'll reach a personal health crisis. It's just a question of when. This is not health care. It's a lottery, and a very expensive one."

Kevin Wagner of Bradford said he and his wife have MVP insurance through Vermont Health Connect. While he doesn't face any serious health troubles at the moment, he said his high deductibles are "anxiety-inducing."

"Every time we need care, it's a matter of, we're going to be paying for it months into the future," Wagner said. "It's definitely a barrier for us. And it does cause us to restrict the care that we seek."

Montpelier resident Kurt Ericksen, who is general manager of Vermont Compost Co., said his company can't afford to offer health insurance but pays a portion of employees' costs for Vermont Health Connect.

Even with that help, Ericksen said his staff sees health coverage as a "poor investment" given the high cost of insurance.

If the state wants to keep younger people insured, "allowing rate increases is not going to help," Ericksen said. "I will guarantee you that the number of insured individuals between 25 and 35 is going to drop. And that's a problem."

Spoon Agave, a member of Brattleboro Town School Board, warned the care board about the nexus between poverty and high health care costs.

"Anything that happens that puts even more stress on these families reverberates to more problems with the kids (and) more expenses in the school," Agave said.

With anxiety over the proposed 2019 rate hikes already running high, Blue Cross likely didn't win any converts last week by filing an amendment that raised the company's proposed increase from 7.5 percent to 9.6 percent (or from 5.3 percent to 6.9 percent without the artificially inflated silver plans factored in).

In explaining its upward rate amendment, Blue Cross cited two recent state legislative changes - an adjustment in chiropractor copayments and a reduction in patient costs for breast imaging.

The insurer also cited the likely growth of association health plans. That change is spurred by new federal regulations, but it has caused concern among Vermont officials who are looking to regulate the new plans.

The worry is that association plans will siphon relatively healthy customers from Vermont Health Connect, resulting in higher premiums for those who stay on the exchange.

"I'm concerned about protecting the marketplace," said Mike Fisher, Vermont's chief health care advocate. "And the concept of these association plans coming back in has a real potential to raise rates for people who buy qualified health plans."

Fisher himself became part of the insurance-rate debate when Blue Cross and MVP sought to block him from offering testimony as an expert witness at the insurers' hearings on Monday and Tuesday.

The hearing officer for the Green Mountain Care Board granted the insurers' request before Monday's Blue Cross hearing. She said the health care advocate plays an "important role" in the rate review process, but that doesn't confer expert-witness status under the state's rules of evidence.

That decision caused some blowback. At the Workers' Center protest, Kelman said he found it "hard to believe that there's a good-faith effort to really listen to the public when they're agreeing to do things like block the public advocate."

Fisher said he was able to testify as a different type of witness at Tuesday's MVP hearing. And officials pointed out that the Health Care Advocate's Office has participated throughout the rate review process by submitting briefs and engaging in cross-examination.

In an interview Wednesday, Fisher said he shouldn't be the center of attention.

"It was pretty silly that the carriers filed motions to block me from testifying," Fisher said. "But honestly, the real issue that I want people to focus on is the rate filing."

The Green Mountain Care Board is scheduled to decide on Vermont Health Connect insurance rates early next month. But due to Blue Cross' late amendment, the board has the option of taking an additional 30 days to consider the insurer's case.

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