VT Digger | July 20, 2017

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.