Regulators deny Blue Cross request to strike public comments

Health care regulators say public comments and statistics on wage growth must be part of the case in which Blue Cross Blue Shield of Vermont is seeking to raise premiums on Vermont Health Connect by more than 12 percent.

The Green Mountain Care Board made the ruling Thursday, in response to the company’s effort to strike information that Vermont Legal Aid’s Office of the Health Care Advocate put in a legal argument Wednesday.

The state of Vermont pays the advocacy office to represent the public during legal proceedings, such as Vermont Health Connect premium cases, in front of the Green Mountain Care Board.

Blue Cross [originally requested] to increase premiums on Vermont Health Connect an average of 12.7 percent. After some legal and mathematical processes, the company [now says] the increase should be 12.6 percent.

The Office of the Health Care Advocate argued in a hearing July 20 that the premium increase should be just 8.7 percent. The advocate then argued in a document submitted after a July 20 hearing that health insurance premiums are already unaffordable.

“If the proposed 12.7 percent increase is approved, between 2014 and 2018,” Blue Cross will have raised premiums by a cumulative 37.9 percent, the document said, more than twice as much as Vermont’s economy grew in that period, and nearly three times what Vermonters’ wages grew in that period.

The health care advocate said rates are unaffordable based on a standard in the Affordable Care Act saying premiums should not cost more than 9.69 percent of someone’s income, and a standard from the Department of Financial Regulation saying that a person’s deductible should not be more than 5 percent of their income.

The advocate then included comments from people who had submitted public comments to the Green Mountain Care Board. In the comments, people generally told personal stories about how they struggle to afford health insurance.

“As a self-employed clinical social worker I am paying almost $600/month for coverage for myself,” one person who was quoted wrote. “This is already outrageous. If the rates rise I will be forced to go without insurance, taking another healthy Vermonter (who supports the unhealthy population) out of the system.”

Another who was quoted wrote: “Last week, I cancelled an MRI that my neurologist ordered because I just can’t afford it, even with insurance. It is outrageous that an insurance plan that already costs 10% of my income doesn’t provide the coverage I need to make important procedures affordable.”

A third person said: “Though I do not make much and work two jobs, I don’t qualify for much of a subsidy and currently pay a lot for health insurance—one-quarter of my monthly mortgage. A rate hike would make it impossible for me to continue to have health insurance.”

A spokesperson for Blue Cross declined to comment on the issue.

Blue Cross argued in legal documents on Wednesday that the board should disregard “new evidence” in six pages of the health care advocate’s 15-page legal argument, and that to do otherwise “would be plain, reversible error.”

Blue Cross said the arguments about affordability are “without proper evidentiary foundation, not substantiated and … not subject to cross-examination.”

The public comments, meanwhile, were “not under oath,” “not subject to direct or cross-examination,” and “cannot be offered as evidence of the truth of what was said,” according to Blue Cross.

The board ruled against Blue Cross.

A hearing officer wrote on behalf of the board that the Office of the Health Care Advocate’s comments are “appropriately sourced” and “reasonably reliable,” and that the evidence “as a whole speaks to the statutory criteria of affordability, equity, and fairness to policyholders.”

The hearing officer also said the information, “stands for the incontestably true proposition that (Blue Cross’) proposed average 12.7 percent rate increase dramatically outpaces Vermont wage growth or any other reasonably selected index of inflation.”

The hearing officer also said the board has to review public comments as part of the case, anyway: “The Board is required by statute to take public comments before, during, and after rate hearings, and repeatedly makes clear at every opportunity that these are accepted by any available medium.”

“It would be excessive legalism to strike the (Health Care Advocate’s) memo in whole or in part over the presence of public comments that Board members are, in any event, required by law to read prior to rendering a decision,” the hearing officer wrote.

The board has not yet issued a decision on how much Blue Cross will be able to charge customers. Such decisions usually come out sometime in August.

Fine Landlord Violators

To the Editor:

I am very grateful for the work that the Town of St. Johnsbury is doing to improve the quality of rental housing in Town. I understand that some landlords object to paying a fee to fund code enforcement. I wonder if a better solution would be to collect fines from the landlords who operate unsafe housing. In that way, the few landlords who choose not to keep up their properties would pay at least some of the costs of that choice.

It seems to me that the great majority of landlords in St. Johnsbury maintain their properties in compliance with our housing ordinance. Only a minority of landlords rent out substandard housing.

The Town already has a Civil Ordinance, Section 6-9, which allows landlords to be fined up to $100 per day for violating the housing ordinance. However, it is my understanding that such fines are rarely imposed. It does not seem fair – or good policy – for landlords who routinely violate the housing code to do so without penalty, while the costs of such violations are imposed on others.

Take, for example, a bedbug infested building in town. The brunt of the suffering from those bedbugs is borne by the tenants and their children. Families suffer bites, secondary infections, sleeplessness, the costs of having to throw away much of their stuff, and often the costs of moving to get away from the bugs.

Moreover, bedbugs can easily and unwittingly be carried from one building to another. So the law abiding landlords bear the costs of having to pay for exterminations that could have been avoided had the other landlord exterminated promptly and properly.

In at least one case, a landlord testified about bedbugs in his rental property when he appealed for a lower tax appraisal– and his appraisal was, in fact, lowered. This is an even more direct cost to the Town and taxpayers. It seems wrong that a landlord could testify about a long term bedbug infestation in his rental property and walk out with a lower tax appraisal rather than a big fine.

The town could limit fines to the most serious problems — like lack of heat or water – and situations where the landlord refused to make repairs after being ordered to by the Town Health Officer. Even that could raise a good chunk of the money needed for a part time code enforcement officer – and probably get some buildings fixed up in the bargain.

I talked about this with one landlord who told me that he has never paid a fine in forty years of landlording and that if the Town started imposing fines, it would raise his costs of doing business. I am not sure this is a bad thing. If we make it less profitable for landlords to operate bedbug infested or otherwise substandard housing, perhaps unscrupulous landlords will choose to bring their buildings up to code or sell them to someone who will.


Maryellen Griffin

Staff Attorney, Vermont Legal Aid

St. Johnsbury, Vermont

Should Vermonters Pay $50 Million More In Health Insurance Premiums? Regulators To Decide

State regulators will have to weigh conflicting testimony as they decide whether to approve a proposal that would increase Vermonters’ health insurance premiums by more than $50 million next year. 

Blue Cross and Blue Shield of Vermont, the state’s largest private health insurance company, is seeking asking the Green Mountain Care Board to approve a 12.6 percent increase in health insurance premiums.

Whether or not that rate increase is warranted depends on who you talk to.

According to Mike Fisher, chief of the Office of the Health Care Advocate, the request well overshoots the amount of money Blue Cross will need in 2018 to cover its policyholders health care expenses.

“Our expert witness evaluated the entire filing from Blue Cross and found four areas where we thought their predictions were too high,” Fisher says.

Fisher’s state-funded office was created to protect consumer interests in Vermont’s nearly $6 billion medical industry, and it hired an independent actuary to vet Blue Cross’ proposed rate.

Fisher says Blue Cross assumes higher utilization trends in 2016 will continue unabated, a conclusion his office now challenges. Fisher also says Blue Cross has overestimated the impact of Vermont’s aging population on overall health care expenditures that will be incurred by Blue Cross’ policyholders.

“And ultimately, [we] recommended to the Green Mountain Care Board that Blue Cross’ proposal was about 4 percent too high,” Fisher says.

That 4 percent translates into real money.

Blue Cross’ proposal would increase Vermonters’ premiums by more than $50 million next year. If the Green Mountain Care Board sides with Fisher’s office, then than number would drop by about $15 million.

But that’s only if they side with the Office of the Health Care Advocate. And Sara Teachout, director of public relations at Blue Cross, says the weight of the evidence lies in favor of Blue Cross. [...]

Seven Years of Disability Discrimination Complaints Target UVM Medical Center

Julie Hay arrived at the emergency department of the University of Vermont Medical Center in Burlington just before midnight on July 15, 2015.

Hay, who was 50 at the time, had just experienced a heart attack. When she arrived in the emergency department, she was upset, found the environment overwhelming, and had difficulty communicating.

While Hay has a host of conditions that complicate her health care — high blood pressure, Parkinson’s disease, migraines, thyroid problems, stomach pain and schizophrenia — her biggest limitation in getting care was the fact that she was born deaf.

Within an hour of arriving in the emergency department, Hay was admitted into the UVM Medical Center, where she stayed for three days. She had not discussed the admission with an in-person interpreter, and during the whole time she was there, she spent a total of 22 minutes signing with a remote interpreter through Skype-like technology, according to findings by the Vermont Human Rights Commission.

Both Hay and her son asked for an in-person interpreter throughout her stay, but she never got one — despite the fact that the hospital had a translation coordinator on staff whose job includes American Sign Language interpretation.

Hay later had a procedure, and the doctor who performed it could not verify to state officials whether she had given informed consent, according to a decision from the Human Rights Commission.

In May, the commission declared unanimously that Hay has the legal grounds to pursue a discrimination case, and that staff at the UVM Medical Center had merely “a surface-level understanding of deaf people and deaf culture.”

The hospital told VTDigger that it did not provide adequate services to Hay, has made efforts to improve its overall treatment of deaf patients, and has tried to settle with Hay and her lawyer, with no success.

“We agree that we did not provide this patient with the quality of communication that she should have received, and that we strive to achieve,” Michael Carrese, the hospital’s spokesperson, said in a statement. “We have apologized to her for that shortcoming.”

“We took this as a learning opportunity, and have strengthened our translation services in a number of ways,” Carrese said.

Nonetheless, Hay’s lawyer said she’s afraid to go back to the hospital.

Seven cases since 2010

For Barbara Prine, the disability lawyer with Vermont Legal Aid who represented Hay, the case was all too familiar.

Since 2010, Prine has personally worked with five deaf patients, including Hay, to lodge seven separate discrimination complaints against UVM Medical Center.

The hospital settled several of those cases before officials started investigations. Hay has not agreed to settle her case, and Prine is now working on a new case with the Vermont Human Rights Commission.

In several of the cases, Prine said, the hospital gave deaf patients access to a remote interpreter through a device similar to an iPad, and using video technology similar to Skype, but the device often doesn’t work or takes too long for staff to turn on.

“Each one of these complainants wanted an in-person interpreter, and instead they got a machine that didn’t work,” she said.

Prine said the patients should be given in-person interpreters to discuss procedures, medical complaints and consent for care. The hospital should only use remote interpreters over the Internet when nurses check in briefly with a patient who has already met with an in-person interpreter.

“Sign language is a three-dimensional language, so it doesn’t play well on a screen,” Prine said. “It just is never going to work as well on a screen. If you’re having a conversation about someone’s condition, you’re getting informed consent for a procedure, you need an in-person interpreter.”

Ed Paquin, the executive director of Disability Rights Vermont, agrees. Although he has had no involvement in these cases, he said the basic idea of a deaf person having a “reasonable accommodation” in the form of in-person interpretation in the hospital is a no-brainer. [...] Read the full article at the link above.

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.”

When health insurance prices go up, how does this affect you and your family?

The Green Mountain Care Board has received proposed rates for 2018 health insurance plans offered on Vermont Health Connect, Vermont’s health insurance marketplace. MVP Health Plan, Inc. (link is external) has requested a 6.7% percent average annual rate increase. Blue Cross and Blue Shield of Vermont (link is external) requests an average 12.7% percent increase.

Attend a Hearing

The Green Mountain Care Board will hold hearings open to the public on July 19 (MVP) and July 20 (BCBSVT). They start at 9 a.m. in Room 11 of the Vermont State House, 115 State Street, Montpelier, Vermont.

The Office of the Health Care Advocate participates in the hearings to help represent the interests of Vermont consumers. Time is also reserved at the end of each hearing for Vermonters who want to make a comment in person.

Submit a Comment

You can submit comments on the rates through July 26 online, by email, by mail or by phone. See our web page for details about how to submit comments, and make your voice heard!

The Board will issue final decisions on the new rates on August 10, 2017.

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.