News

Public Advocates Take Aim at Blue Cross Rake Hike Request

A public advocate told regulators Thursday that the state’s largest health insurance company does not need to increase premiums 12.7 percent on Vermont Health Connect in 2018.

The advocate from Vermont Legal Aid’s Office of the Health Care Advocate brought in an actuary who said the company could afford to reduce its premium request by about a third — to an 8.7 percent increase.

The actuary testified in front of the Green Mountain Care Board, which regulates hospital budgets and health insurance premiums. The case being considered Thursday affects about 70,000 people who get Vermont Health Connect insurance from Blue Cross Blue Shield of Vermont either on the exchange or through an employer.

Blue Cross is seeking the highest increase it has requested since the company started offering plans on Vermont Health Connect in 2014.

The company originally sought to increase premiums an average of 12.7 percent. The company updated that request to 12.9 percent based on new data. Actuaries for the Green Mountain Care Board said the number should be 12.6 percent, and the company agreed with that analysis.

Blue Cross has cited several reasons for the premium increase, including Vermont’s aging population.

Kaili Kuiper, a lawyer for Vermont Legal Aid’s Office of the Health Care Advocate, said that if the insurer is allowed to raise its premiums that much, customers’ premiums would have increased a cumulative 38 percent since 2014.

She said that while “many factors” in the increase are outside the company’s control, the company’s actuaries have not “applied sound actuarial methodology” and could shrink that premium increase “by increasing the scientific rigor” of their analysis.

Peter Horman, an actuary and the expert witness for the Office of the Health Care Advocate, described several ways that he did the math differently from Blue Cross and arrived at the conclusion the company could cut the increase by 4 percentage points.

Horman said that’s because the company showed “conservatism” in calculating rates. He described the issue like this: “It seems that if they have a concern of something increasing, they’ll reflect it in the rates, but if they have a concern with decreasing, they’ll hold it steady.”

Horman also questioned the company’s methodology to estimate Vermont’s aging population, which he said should be an entire “demographic modeling exercise.” To model the issue accurately, said Blue Cross would need to account for the fact that most people use Medicare when they get to age 65.

Horman said the company’s decision to account for the aging population is simply a concern, not justification for raising premiums.

Additionally, Horman said a premium increase as high as Blue Cross has requested would lead to an “adverse selection spiral,” in which young, healthy customers choose to go without insurance, in turn driving up insurance prices further when older, sicker people remain in the market.

Board members did not ask Horman any questions.

During a tense cross-examination, Jacqueline Hughes, the lawyer for Blue Cross, asked Horman how much money the Office of the Health Care Advocate was paying him for his services.

Horman said he had made $20,000 through June and will bill at least $12,000 more for his services since then. He said he charges about $300 an hour for his time.

Hughes also questioned the financial stability of a company he worked for previously, the Neighborhood Health Plan in Boston. She also asked him about whether the company took losses big enough to require them to raise premiums by large amounts.

Horman said he was working for a financially challenged company at the time. “I’m not sitting here saying I’ve never given a high rate increase,” he said, but “given the high increase, Blue Cross is not incredibly financially challenged.”

Paul Schultz, the chief actuary for Blue Cross, said during his testimony that he did not agree with any of Horman’s results and that the board should not impose the lower premium increase.

“I don’t think Blue Cross is in any danger of an adverse selection spiral,” Schultz said.

The board will hold a special public comment period July 27 and continues to accept public comment through its website, before making a decision at the end of the summer.

Attorney General to hold forum on health care costs

Attorney General TJ Donovan will hold a public forum on health care costs Tuesday at 5:30 p.m. in Contois Auditorium at Burlington City Hall.

Donovan’s office runs a Public Protection Division dedicated to consumer affairs and enforcing antitrust laws.

Amy Cooper, the executive director of HealthFirst, a group that represents independent doctors, is one of the scheduled speakers. Another is Judy Henkin, the general counsel for the Green Mountain Care Board, which regulates hospital budgets and insurance premiums.

Mike Fisher, the chief health care advocate for Vermont Legal Aid, will also speak. Additional speakers will be announced closer to the event, according to Natalie Silver, a spokesperson for Donovan.

“The cost of health care is a consumer protection issue,” Donovan said in a news release. “Consumers have questions. We are trying to give Vermont consumers access to information and the opportunity to ask questions on this topic.”

Scott Administration: Outside Audit of Vermont Health Connect Tells ‘Story of Improvement’

A recently released external audit of Vermont Health Connect says the state-run insurance exchange has met all requirements set forth by the federal government.

Consumers of Vermont Health Connect have endured a host of troubles since the program launched three and a half years ago. Public perception had run so sour that Republican Gov. Phil Scott ran on a promise of doing away with a state-run exchange altogether.

But a new audit, which examined exchange operations during the last fiscal year, yielded an “unqualified opinion” from the independent firm that conducted the analysis. Cory Gustafson, commissioner of the Department of Vermont Health Access, says that’s “as good as it gets when it comes to audits.”

“The report to me really speaks to a story of continuous improvement at Vermont Health Connect,” Gustafson says.

Two years ago, results of a similar audit were far worse.

Due to a laundry list of operational shortcomings, auditors at the time deemed Vermont Health Connect to be out of compliance with federal regulations.

“The big problems that were seen in 2014 and early 2015 are less and less and less and the service levels are higher and higher and higher,” Gustafson says. [...]

Mike Fisher is the chief of the Office of the Health Care Advocate, a consumer advocacy organization run by Vermont Legal Aid. Fisher says measures of consumer satisfaction continue to rise.

“The numbers continue to get better,” Fisher says. “The number of Vermonters who are caught up in real challenges are smaller and smaller.”

Fisher, however, says those improvements mean little to the Vermonters who still struggle with billing errors, lapses in coverage, or extended delays making changes to their policies.

“For those Vermonters who have a real challenge, that story that the numbers are getting smaller doesn’t matter. They’re still frustrated as can be,” Fisher says. “I both want to congratulate the exchange team for doing some good work and also continue to communicate to Vermonters that more work needs to be done.” [...]

On June 6, Eric Clemons of Comcast Newsmakers interviewed Vermont Legal Aid Mental Health Law Project Director Jack McCullough. Watch the video below for more information about the work of the Mental Health Law Project:

3SquaresVT regional conferences are in Montpelier, Rutland, Winooski

Over the next few weeks, advocates from a range of organizations will have three different opportunities to attend a 3SquaresVT Regional Conference near them to discuss outreach and advocacy for Vermont’s largest nutrition program, 3SquaresVT (formerly food stamps and known nationally as SNAP). The conferences will offer an opportunity for advocates to learn more about how the 3SquaresVT program works, hear from policy experts from the Economic Services Division of the Department For Children and Families where applications are processed, discuss how to address stigma and confront negative myths about the program, learn about advocacy strategies from Vermont Legal Aid, and network with colleagues from their region. New this year, the conferences will also each feature a keynote speaker. Sean Brown, Deputy Commissioner of DCF will speak at the Montpelier and Winooski conferences and Ken Schatz, Commissioner of DCF will speak at the Rutland conference.

3SquaresVT provides benefits to approximately 78,000 Vermonters to buy more nutritious food at grocery stores and farmers markets. The program is successfully reaching many Vermonters, decreasing hunger in our communities and improving the health of children, families and seniors. However, there are still many eligible Vermonters not participating, thus losing out on benefits to which they are entitled and need.

1 in 9 Vermonters is food insecure, meaning they do not always have enough to eat for a healthy and active life. “3SquaresVT is one of the best ways to prevent food insecurity for families, and we must do everything we can to help eligible Vermonters access these benefits,” says Marissa Parisi, Executive Director of Hunger Free Vermont. “By bringing so many advocates together to talk about 3SquaresVT collectively, this conference is helping us achieve that goal.”

The 3SquaresVT Regional Conference series is being organized by Hunger Free Vermont, in collaboration with the Department for Children and Families and the statewide 3SquaresVT Work Group.

About Hunger Free Vermont: Hunger Free Vermont (formerly the Vermont Campaign to End Childhood Hunger) is a statewide nonprofit organization that works with state agencies and community groups to end the injustice of hunger and malnutrition for all Vermonters. Since 1993 Hunger Free Vermont’s outreach programs have substantially enhanced Vermont’s nutrition safety net and increased access to nutritious foods.

Governor Phil Scott signed legislation designed to help Vermonters with long-term care needs and protect vulnerable adults from financial exploitation. The new law updates the Long-Term Care Ombudsman statute to conform to the Older Americans Act (OAA). The law also creates a civil private right of action for vulnerable adults who have been subjected to financial exploitation.

“My Administration is committed to ensuring that vulnerable Vermonters are safe and protected from financial exploitation,” said Gov. Scott. “That means ensuring our laws conform to federal laws designed to help them and providing access to the courts to stop or prevent financial exploitation.”

Advocates and the Office of the Attorney General supported amending the new law to include provisions allowing financially exploited vulnerable adults to seek relief in civil court.

“At Vermont Legal Aid, we see increasing numbers of vulnerable adults becoming victims of financial exploitation. We are pleased that this new law will help this targeted population bring civil suits against people who have exploited them,” said Jacob Speidel, a Vermont Legal Aid attorney who brought his experiences representing senior citizens to the attention of legislators.

“Vermont has a long, proud tradition of protecting its vulnerable citizens,” said Attorney General T.J. Donovan. “We are pleased to have contributed to the passage of this important legislation,” he said.

Assistant Attorney General Jamie Renner testified in support of the legislation. “Vermonters who are financially exploited should have a voice and be able to get relief,” said Renner. “This new law will help accomplish that goal,” he said.

The Older Americans Act of 2016 reauthorizes programs for FY 2017 through FY 2019. It includes provisions designed to protect vulnerable elders by strengthening the Long-Term Care Ombudsman program and elder abuse screening and prevention efforts. It also promotes the delivery of evidence-based programs, such as falls prevention and chronic disease self-management programs.

Gov. Scott signed the new law on Thursday, May 4, 2017. The sections updating the Long-Term Care Ombudsman program take effect on July 1, 2017. The sections regarding protection of vulnerable adults from financial exploitation take effect immediately.

Coalition of Vermont Health Care Organizations Forms to Oppose the American Health Care Act

A coalition of Vermont health care organizations has formed to oppose the American Health Care Act (AHCA) and clearly state that its passage by the United States House of Representatives is a major setback for health care in our country. The AHCA threatens Vermonters’ access to affordable health insurance coverage and violates Vermont’s core values.
 
If it becomes law, the AHCA will severely reverse gains made at the national level by the Affordable Care Act (ACA) including increased coverage levels and affordability, and other protections such as mental health parity. A March 2017 Congressional Budget Office (CBO) report found that up to 24 million Americans will lose their health insurance under the AHCA. While the revised bill was passed before the CBO could issue an updated forecast, it is clear that the impact will be significant. The AHCA will increase the number of uninsured Vermonters and harm Vermont’s health care system and economy.
 
The coalition includes Blue Cross Blue Shield of Vermont, the Office of the Health Care Advocate, Planned Parenthood of Northern New England, the University of Vermont Medical Center, the Vermont Association of Hospitals and Health Systems, Vermont Care Partners, the Vermont Coalition of Clinics for the Uninsured, and the Vermont Medical Society.
 
Each of these organizations is committed to improving access to high quality, affordable health care in Vermont and continues to work independently and in collaboration toward this united goal. The coalition calls on the US Senate to reject the AHCA and any other efforts to roll back access to affordable, high quality health care.

The Office of the Health Care Advocate (HCA) helps Vermont consumers with a broad range of problems and questions related to health care services and health insurance. The HCA acts as a voice and advocate for consumers in health care policy matters before the Vermont legislature and government agencies that oversee insurance and health care programs. The Office of the Health Care Advocate is a project of Vermont Legal Aid.

Vermont Legal Aid (VLA) is a non-profit law firm that provides legal advice and services to individuals and families throughout Vermont who are facing a civil legal problem that threatens their rights, shelter, job, health or well-being. VLA began serving clients in 1968.

ORGANIZATIONAL CONTACTS:   
Blue Cross Blue Shield of Vermont
Andrew Garland | Vice President of Client Relations and External Affairs
garlanda@bcbsvt.com
802-371-3225

Office of the Health Care Advocate, Vermont Legal Aid
Mike Fisher | Chief Health Care Advocate
mfisher@vtlegalaid.org
802-383-2226

Planned Parenthood of Northern New England
Meagan Gallagher | President & CEO
mgallagher@ppnne.org
802-448-9778

The University of Vermont Medical Center
Mike Noble | Senior Media Relations Strategist
milner.noble@uvmhealth.org
802-847-2886

Vermont Association of Hospital and Health Systems
Devon Green | Vice President of Government Relations
devon@vahhs.org
802-223-3461 x104
VAHHS Statement on AHCA: http://vahhs.org/aca-repeal-vote.html

Vermont Care Partners
Julie Tessler | Executive Director
julie@vermontcarepartners.org
802-223-1773 x401

Vermont Coalition of Clinics for the Uninsured
Laura Hale, Executive Director
vtcoalitionofclinics@gmail.com
802-238-7994
Peter Youngbaer, President
phwc@sover.net
802-479-1229

Vermont Medical Society
Justin Campfield | Communications
jcampfield@vtmd.org
802-223-7898
VMS Statement on AHCA: http://www.vtmd.org/vms-releases-statement-ahca

Vermont lawmakers hope to stem ACO abuse of tax dollars seen in other states

Members of the Vermont House on Wednesday reassigned to the Committee on Health care a bill requiring open meetings for accountable care organizations.

The move marked a next step in the debate over balancing the rights of private entities with the need for public accountability.

“This is really important. ACOs are private, but at the same time are involved with individual health records and Medicaid dollars that we need to regulate,” state Sen. Virginia Lyons, D-Chittenden, co-sponsor of S.4 told Vermont Watchdog.

ACOs are private networks of health care providers that cooperate together under a common umbrella administration with the goal of regulating health care expenses.

OneCare, an accountable care organization owned by University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center, is contracted with the state to manage the care of 30,000 Vermont Medicaid patients in what the governor has considers a trial-run of the all payer model.

If the trial is successful, OneCare will morph with other ACOs in the state to form the Vermont Care Organization and manage the entirety of Vermont’s Medicaid, Medicare, and commercial insurance funds. In 2018, VCO will take over complete Medicaid coverage as an initial step. [...]

Does Vermont have the regulations to protect Medicaid dollars?

Mike Fisher, chief health care advocate for Vermont Legal Aid, told Watchdog the Green Mountain Care Board is currently addressing that question.

Act 113, signed by former Gov. Peter Shumlin in May, charges the Green Mountain Care Board with creating rules to prevent the abuse of the cost-saving financial incentive structure.

However, Lyons, along with co-sponsor state Sen. Tim Ashe, D/P-Chittenden, the Senate president pro-tem, believe that Act 113’s language was too vague, and sought in S.4 to clarify what business could be conducted in executive session.

While Act 113 states that all business “not confidential or proprietary” should be conducted in public, S.4 clarifies that executive session is the exception to the rule. The bill lists seven acceptable uses for executive session, including protection of private health care data, litigation and personnel matters.

Todd Moore, chief executive officer for OneCare and Vermont Care Organization, testified against the bill in Senate committee hearings. “It is unclear what problem or anticipated problem this change in language seeks to address. S. 4 changes Act 113 before we even know how well it is working,” he said.

Emanuel said that, in the case of North Carolina, clearly defining what business accountable care organizations could conduct behind closed doors would have protected patients.

“[ACOs] are using exceptions for open meeting requirements in broad, expansionist ways. This information concerns our tax dollars, and the deliberations are important,” she said. [...]

While legislators and the Green Mountain Care Board have work cut out for them, Fisher, who advocates for the rights of consumers in Vermont, says the legislation is “an important first step.”

Daniel Richardson: Legal Aid services benefit all Vermonters

Editor’s note: This commentary is by Daniel Richardson, who is a partner at the Montpelier law firm of Tarrant, Gillies & Richardson. He is the president of the Vermont Bar Foundation, which oversees private grant and fundraising for Legal Aid, Law Line and other legal charities. He is also the past president of the Vermont Bar Association.

Sandwiched between the headlines last week about President Trump’s proposals for Meals on Wheels and Big Bird was news that the administration will also seek to end funding for the Legal Services Corp. (LSC). For Vermonters, the radical cuts proposed by the president portend disaster.

The LSC is a nonprofit corporation that was formed by an act of Congress in 1974. Its mission was and remains to ensure equal access to justice under the law for all Americans. In advocating for the creation of the LSC, President Richard Nixon wrote:

America’s system of law now requires equal treatment for all in our courts of criminal justice. It is no less important that equal access be afforded those who seek redress through our civil laws. We propose no special favors for any group in our society, nor do we seek to mandate the use of the legal system to the exclusion of other social institutions as instruments of social progress. We propose, simply, to protect and preserve a basic right of all Americans.

The LSC and its various state-level entities and partners, such as Legal Services Law Line of Vermont and Vermont Legal Aid, fulfill this promise by putting lawyers in courthouses across the state to represent individuals who could not otherwise afford it. The LSC model is based on a simple idea: If everyone has legal representation, then everyone benefits. This has been proven true over and over again.

Cuts to the LSC and its state partners are wrong. They threaten not only those most vulnerable, but they have the potential to deteriorate a legal system that struggles each day to do more with less. In the short term, these cuts mean fewer lawyers on the ground providing legal services to those in need. In the long term, these cuts threaten to shut off a critical set of services that benefit all Vermonters.

Even if Trump’s plans for total defunding are not enacted, cuts to the LSC and its state partners are all but guaranteed. Eric Avildsen, executive director of Vermont Legal Aid, said recently that his organization and Law Line are anticipating cuts of 5 to 10 percent within the next six months as part of continuing funding resolutions that the House and Senate are likely to approve. Any budget eventually passed will likely deepen the reductions further.

On top of cuts at the federal level Gov. Phil Scott’s budget proposal contains two steep cuts to Legal Aid that total $100,000. These cuts would also mean the loss of matching federal funds. When totaled with the anticipated federal reductions, Vermont faces a loss of over a million dollars in LSC and legal aid funds.

Spend a little time on the Vermont Legal Aid website. You will see that while Legal Aid and LSC provide legal services to the underprivileged, their services are also geared toward larger problems of society, which affect us all.

For a self-represented litigant, navigating court process is like deciding on the right spot to make an incision to remove your gallbladder.

Perhaps the best example of Legal Aid’s large mission is its work in 2008 during the mortgage foreclosure crisis. This crisis hit Vermont. like every other state. with the force of a tsunami. Overnight, banks transformed from lending and investment institutions into foreclosure mills. The number of foreclosure filings spiked to historic highs. The court system was inundated with reams of computer-generated foreclosure documents and hundreds of panicked homeowners were left trying to make sense of a dense, arcane legal process to save their homes.

Into this breach Legal Aid attorneys, led by former Poverty Law fellow Grace Pazdan, stepped up to provide both courtroom triage and advocacy on a state level for better process. As a result of Legal Aid’s work, the Vermont General Assembly and Gov. Jim Douglas adopted a foreclosure mediation program for all homeowners (regardless of income) and a process to slow foreclosures down and require banks to come to the table, negotiate and talk. This was a win-win-win situation. Homeowners gained a forum to talk directly with the banks and a last chance to save their home. Banks received a reliable process where they could negotiate repayment plans without forgoing their rights. Vermonters were spared the crash in home prices that affected so many other communities around the country.

In the past 10 years, LSC and Legal Aid services have grown more important. Vermont, like many states, is facing a legal service crisis. Each year, fewer and fewer Vermonters can afford to hire an attorney, and each year more decide to either forfeit their claims or simply go it alone. By the Vermont Supreme Court’s most recent reports, approximately 72 percent of all cases in the system involve one or more self-represented party. [...]

As Vermonters and as citizens, we have to ask ourselves if the savings promised by the cuts proposed in Washington and Montpelier are worth the price we will pay in the long term. A cut to Legal Aid on the state level might save you a penny on your tax bill. A cut to LSC on the federal level is such a small drop in the bucket it won’t even show up on your return in April. But with each cut, the cost of doing business goes up substantially. For low-income Vermonters, cuts at the state and federal level will mean fewer resources to count on when trouble arises. For the rest of us, it will mean more delays, greater legal costs and longer waits. For employers and businesses, it means a more fragile workforce as employees facing issues previously covered by Legal Aid projects will have nowhere to go. Minor problems will become major. Major problems will become debilitating. That is a cost and a reckoning for each of us, and one that is likely to exceed the penny we keep today.

As we head into the final budget season in the Statehouse, the General Assembly and the governor must restore Legal Aid funding to its current levels. Keep this valuable program in place. At the same time, we need to remind the president and Congress that legal services funding is important and an essential part of protecting and preserving the basic rights of all Americans.

Policy hailstorm strikes Statehouse

Written by Rep. Dave Yacovone

As I was moving through the Statehouse last week from meeting to meeting, I could not get the words of WCAX weatherman Gary Sadowsky out of my head. When there is a big storm, Gary often says, “It’s rain’n in Canaan and pour’n in Warren.”

Well, we had a policy hailstorm raining on us last week in Montpelier.

First came the news that the proposed Trump budget would eliminate the fuel heating assistance program next year, causing roughly 21,000 Vermont households to lose $18 million in financial help to pay their heating bills.

Today, 364 households in Elmore, Morristown, Woodbury and Worcester, the towns in the Lamoille-Washington District, rely on this assistance to heat their homes.

That news was followed by word that the Community Development Block Grant that helps fund village improvements throughout the state will be eliminated. Lamoille County alone has received $7.6 million over the years, including $600,000 to help make affordable housing available in the Arthur’s Building in Morrisville.

On top of that we learned that Community Action, one of the mainstays of the social safety net, would be zeroed out of the budget, as would Vermont Legal Aid. Much of the anticipated funding to help us clean up Lake Champlain would be gone too.

This budget proposal could be the largest transfer in wealth from the poor to the rich in our lifetime as even more tax breaks for the wealthy are proposed.

If all of that was not enough, we continue to hear that the “Repeal and Replace” Trump/Ryan health care plan will cost Vermont a staggering $200 million in lost Medicaid money to help pay for insurance coverage for thousands of Vermonters.

And, finally, was the reminder that we have a $3.2 billion unfunded retirement liability for teachers and state employees that needs funding in the future.

A friend of mine suggested filling all of these budget needs with taxes from Vermont would be like trying to fill the Grand Canyon with a spoon. Legislative leaders are suggesting we should keep our calendars open so we can possibly reconvene in November, after the federal budget is finalized, to determine what we can and should do.

There will be those who rally around tax increases to solve the problem. Others will see this as an opportunity to downsize government. I think I will heed the advice of my late mother who used to tell me, “All things in moderation.”

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