News

Legislature, insurers look to cover federal health subsidy cut

In the wake of President Donald Trump’s cutoff of federal funding for a health insurance subsidy in October, state officials, insurers and lawmakers are considering a plan to ease the impact on Vermonters.

Lawmakers anticipate moving quickly to allow reworking of some health care plans, as the insurance rate-setting process for next year is set to kick off within weeks.

A Trump executive order in October ended federal funding for a subsidy, part of the Affordable Care Act, aimed at stabilizing insurance premiums and keeping costs manageable for consumers.

However, a mandate in federal law continues to require insurers to offer a silver-level health plan at reduced cost to people whose income is up to 250 percent of the federal poverty level. Without federal dollars, insurance companies are left to bear the cost of that benefit themselves, which is expected to drive up premiums for all health plans.

Now, key players in Vermont’s health insurance sector are backing a proposal meant to prevent across-the-board increases because of Trump’s action.

The proposal would take advantage of a different federal subsidy — the premium tax credit — to make up for the loss of cost-sharing funding.

Under this scenario, premiums would increase only on silver-level health plans sold on Vermont Health Connect. Blue Cross Blue Shield puts that increase at 10 percent. Customers would be shielded from paying the higher rates themselves.

For most consumers, the premium tax credit would cover the rate increase, according to the plan’s architects. The credit is available for people with incomes up to 400 percent of the federal poverty level. Based on the 2017 federal poverty level, the credit is available for individuals with an income up to $48,240; for a family of four, the cutoff is $98,400.

People who buy silver plans through Vermont Health Connect but aren’t eligible for the tax credit — there are about 2,195 such customers now — would pay the full cost of the higher premium if they purchased their plan through the exchange.

But to help keep costs down for those people, the insurance companies would develop a similar plan with lower premiums that would be available directly from the companies. Lawmakers’ authorization is required for the insurance companies to develop parallel silver-level plans to offer outside Vermont Health Connect.

Only Vermont, North Dakota and Washington, D.C., did not make changes in the wake of the October executive order. According to Blue Cross Blue Shield, 37 states implemented a plan similar to the one lawmakers and health care officials are considering in Vermont.

Blue Cross Blue Shield initially drew up the plan, which has been endorsed by the state’s other major insurance company, regulators, advocates and other key stakeholders.

“We fully support it,” Susan Gretkowski of MVP Health Care told the House Health Care Committee on Wednesday. “We do feel it is the best way to protect each group of people in the silver level.” [...]

Chief Health Care Advocate Mike Fisher, of Vermont Legal Aid, also supports the plan.

“It will avoid many Vermonters seeing increased premiums,” he said.

It’s important for people to be aware of available subsidies, Fisher said.

He encouraged people to pay close attention to the amount they must contribute to their insurance plan when they are enrolling through Vermont Health Connect. Though the total costs may be high, their contributions will be much lower, he said.

“The sticker shock of the total premium scares people, understandably,” Fisher said. “It’s really important that people look at what their family contribution requirement is, and that will be unchanged.”

He and others emphasized the need for a campaign to raise public awareness of the change. [...]

Many Vermont Tenants Stuck in Unsafe and Unhealthy Housing

Despite regulations intended to protect them from substandard housing conditions, many Vermont tenants still live in unsafe and unhealthy homes. Today, Vermont Legal Aid released a report, Renters at Risk: The Cost of Substandard Housing, to examine the problem and call for policy solutions to address substandard housing. The report was the result of data analysis and interviews with tenants, advocates, and public officials.

Our key findings are as follows:

1.       Tenants who suffer from the various impacts of unsafe and unhealthy housing conditions experience increased health care usage, mental health problems, disruption to school and work, and homelessness.

2.      The most common problems tenants face are pests and plumbing problems.

3.      Threat of eviction and lack of affordable housing options often prevent tenants from reporting rental housing health code violations.

4.      Town health officers are commonly unpaid volunteers without the time or experience necessary to address health code violations.

5.      We can and should make changes to our code enforcement system.

In our report, the voices of nine tenants in the struggle for healthy housing reveal the long-lasting impacts of substandard housing. It is clear that their experiences with inadequate housing conditions are not isolated instances – many other renters throughout Vermont suffer serious problems in their rented homes. For example, Amberly, a tenant in Rutland, had to live with a severe rat infestation (see attached photo). It appeared that they were coming into her home from the outside through the basement.  Amberly set traps and did what she could, but had to live with rats -- in her home, in her kitchen, chewing on her possessions – for months before she could move out. Amberly developed hives and other medical issues in addition to handling the plain stress of a rat infesation, all while trying to juggle work and raising two small children.

“This kind of situation is too common, and it is not just a problem for tenants,” according to Maryellen Griffin, one of the attorneys at Vermont Legal Aid who worked with lead author Tessa Horan on the report. “These problems also hurt good landlords, towns, and taxpayers. The medical costs, the downward pressure on property values, the risk that the rats will continue to multiply and migrate to other buildings, not to mention the human suffering – these are problems for all of us.  Allowing our housing stock to continue to degrade threatens the health of our residents as well as the tax base and the viability and vibrancy of our towns.”

We are proposing legislation to address this issue using three strategies:

1.       Strengthen Town Health Officers’ authority to issue orders and enforce them, and make it unlawful to re-rent an apartment if the landlord has not complied with the orders.

2.      Direct the Department of Health to provide more coordinated support to Town Health Officers.

3.      Create a statewide database of rental housing to collect better data about the problem.

As Jonathan Bond from Vermont Tenants Inc. said in the report, “If we’re going to have a really basic health code, I would like to see the basic health code being enforced, and right now it’s just not being enforced.”

To read our full report and list of recommendations to address the impacts of substandard housing on Vermont tenants, visit our website at http://www.vtlegalaid.org/renters-at-risk.

Open enrollment starts Wednesday for Vermonters who want to sign up for a health insurance plan for next year through the state's online exchange or existing subscribers who want to change to a different plan.

The annual enrollment period runs from Wednesday to Dec. 15.

Officials tell Vermont Public Radio that Vermont Health Connect's technical problems have largely been fixed and operations have improved dramatically in the past year.

Open enrollment comes as President Donald Trump has done away with federal subsidies to health insurance companies used to reduce out-of-pocket expenses to low- to moderate-income Vermonters.

Mike Fisher, chief health care advocate for Vermont Legal Aid, says the benefits will still be available and it's up to the insurance companies to figure out how to fund them.

Phantom rule could leave special needs kids, parents in limbo

State officials thought they’d had a rule in place since 2013 requiring school officials to respond within 15 days when a parent requests that a child be evaluated for special education services.

Now it turns out the rule was never filed properly with the Vermont Secretary of State’s office. Some parent advocates saying that means families have no recourse when school officials drag their feet.

Because some of the rules passed by the Vermont Board of Education are not the same as those posted on the Secretary of State’s website a new rule-making process must take place in order for the 15-day standard to go in effect, officials said.

The state Board of Education and Agency of Education say they are swamped with implementing Vermont’s Act 46 school district consolidation law, and don’t have time to deal the special education rules.

Now they’re asking local school districts to meet the 15-day response time as a “best practice.” But parent advocates say that gives them less power to challenge inaction by schools.

“The difference between best practice and a rule is that a rule is a procedural safeguard for parents’ rights,” said Karen Price, the family support director with Vermont Family Network.

With a rules violation, parents could enter a formal complaint process, Price said. When looking to cure a deviation from best practice, “a parent is relying on the good faith on the part of the school,” she said.

When a parent suspects their child may need special education services, the first step is to ask for an evaluation to see if the child is eligible. Price said that before the state board added the 15-day rule there was no defined timeline for schools to respond to parents’ requests.

“It has been a long-standing problem that parents that suspect their child has a disability and they make a request then never hear back,” Price said. “It happened a lot.”

Price said she knows of one parent who has since learned she cannot file an administrative complaint based on the 15-day rule.

“Now that it’s no longer a rule, she has no right to complain,” she said.

One parent in the Franklin-Northwest district said she had planned to file a formal complaint after becoming frustrated about the school’s lackluster response to her request for a special education evaluation for her child.

“I was going to lodge a complaint about the 15-day rule, but now I’m stuck with not knowing if it makes sense because the rules are changing,” said the parent, who asked for anonymity because being publicly identified could harm her own employment situation. She said she had been notified of the change to the rule by staff at Vermont Legal Aid.

“I believed the information I was finding online was correct. I’m really disappointed that they could make this type of mistake,” she said, adding that guidance is not good enough.

“If a child needs special services, it can’t wait. It needs to be addressed as soon as possible. In the meantime, while we are waiting, a child is suffering,” she said.

The agency has strongly advised school districts to use the 15-day rule until officials have a chance to update it, according to an agency memo released in August.

Haley Jones, spokesperson for the agency, said school districts have been using the 15-day rule since 2013 and everyone is used to it. “We have not heard that anyone intends not to continue to use it,” she added.

In 2013, the state Board of Education made a number of changes to the special education rules, mostly to bring them into compliance with new federal laws. Most of the changes did show up in the official rules posted by the Secretary of State’s office, but a few did not.

“This is the kind of thing that happens when you are short-handed and the state board also has no staff,” said William Mathis, vice chair of the board.

Recent years have been marked by increasing responsibilities for the state board and Agency of Education, including the implementation of the Act 46 school district consolidation law, without long-promised increases in staff, officials said.

The federal government requires schools to respond to parents within 60 days and the state has remained in compliance.

Mathis said the state board added the 15-day rule because members wanted to be more responsive and responsible to parents.

“But through a huge foul-up and a lack of staff to check and double check the work, it didn’t happen,” he said, adding that it will be put back in when the state board goes through the rules process again.

But that is little comfort to Vermont families, said Price. “It is the Agency of Education’s job to have these regulations be correct and protect parents’ rights. As a parents rights organization this is not a response we are happy with – they are short of people? Short of time? They can’t get to this? It isn’t right for parents of children with disabilities for this to remain unfixed.”

Mathis said he isn’t sure when they can start it up since the board and the agency have to deal first with Act 46 and the private school rules series 2200. “It is a matter of the workload for the Agency and for the board. We don’t have any staff.”