Editor’s note: This op-ed is by Christine Oliver, the CEO of Vermont Health CO-OP.
For many years, Vermonters have been calling for more affordable and accountable health insurance options – options that put their personal health ahead of profits.
If licensed, the Vermont Health CO-OP would be the state’s only member-owned and member-governed health insurance provider – required, as a federally approved CO-OP, to reinvest its surplus revenue in lowering costs, expanding coverage and improving the health of its members. These are precisely the advantages President Obama and Congress intended when they included authorization and funding for healthcare CO-OP’s in the federal Patient Protection and Affordable Care Act (ACA).
The recent decision by the Department of Financial Regulation (DFR), however, contains many inaccurate and misleading statements. So many that it’s hard to know where to begin. Nevertheless, it is our view that Vermonters have a right to know the truth about a regulatory process that has denied them access to the value – and the values – offered by the Vermont Health CO-OP.
DFR has not licensed a new health insurance provider in more than 50 years, so due diligence is appropriate. I value and respect regulation – I was a government regulator for more than a dozen years. We entered the licensure process in good faith and have been working through it for 10 months. To say we were blindsided by the decision is an understatement. There is no honest way to leap from our last exchange with DFR to the order that was issued. It doesn’t add up on so many levels.
Here are a few key facts:
We repeatedly advised that these rates would be lowered through our own process, the DFR process and and through the Green Mountain Care Board’s ultimate rate approval process. Our plans would be very similar in cost to others on the health care exchange – less expensive in some cases – with the added benefits of being a member-owner.
DFR has misled Vermonters on a range of facts, most notably our rates and enrollment projections. The rates they cite were proposed as a placeholder to start the review process. We repeatedly advised that these rates would be lowered through our own process, the DFR process and and through the Green Mountain Care Board’s ultimate rate approval process. Our plans would be very similar in cost to others on the health care exchange – less expensive in some cases – with the added benefits of being a member-owner. Every argument DFR offers about enrollment is based on its distortion of rates.
All of the startup risk is covered by the federal Centers for Medicare and Medicaid Services (CMS). The federal government, having scoured our books and plans, has approved the CO-OP. Not one Vermonter would be at risk – financially or medically – when the Vermont Health CO-OP is licensed. The illusion of risk to the consumer is patently false.
Our board chair, who has day-to-day responsibilities during this startup phase, has been the lynchpin in securing federal approval of the CO-OP option for Vermonters. CMS is confident in his ability to deliver membership necessary for the CO-OP to succeed. Our board is composed of some of Vermont’s leading businesspeople and a well-respected physician with experience in finance, insurance and health care.
The CO-OP has built many innovations into the organization and our plans. We are designing a system of true collaboration between the member, the family doctor and specialists to better coordinate care and improve quality. We are eliminating barriers to mental health and substance abuse services including prior authorization for care. We’ll also offer personal, one-on-one wellness coaching to our members to improve the collective health of members.
These are just a few of our innovations in care.
There are other misleading statements contained in DFR’s decision – too many to address here. We will post a more detailed response on our website www.vthealthcoop.org.
We did meet recently with Gov. Shumlin, who expressed his support for the CO-OP concept and hope that an agreement could be reached. DFR has the ability to reopen the file, apply accurate and updated information, and work in a collaborative way to complete the licensing process.
Vermonters want a more personal alternative to traditional insurance companies; a choice to own their health and have a real voice in their coverage and care; an option that puts their personal health ahead of profits.
We are going to fight for the opportunity to offer you this option.
