[M]VP Health Care is asking state regulators to let it increase how much it charges Vermont Health Connect customers by an average of 6.3 percent next year.
The insurer covers about 10 percent of people and small businesses who buy insurance through the health care exchange. The rest get insurance through Blue Cross Blue Shield of Vermont, which had a similar hearing Wednesday.
Every year since Vermont Health Connect insurance plans launched, both MVP and Blue Cross have asked the Green Mountain Care Board to increase how much they are allowed to charge customers. For 2015, MVP requested a 15.3 percent increase and received 10.9 percent. For 2016, MVP requested 3 percent and received 2.4 percent.
For 2017, MVP proposed in May to raise prices an average of 8.8 percent — similar to Blue Cross’ request. On July 11, an actuary for the regulators said that number should be 3.7 percent. MVP took the actuary’s opinion into consideration and made a counteroffer of 6.3 percent.
Gary Karnedy represented MVP in a hearing before the board Thursday, defending the 6.3 percent increase. To explain the issue, he used an analogy: Two actuaries and the chair of the Green Mountain Care Board walk into a bar and play darts.
One actuary — the one for MVP — says he can tell where a third dart will hit based on where the previous two hit, Karnedy said. The second actuary — the one for the board — wants to predict based only on where the second dart hit. The proverbial first dart is certain data from 2014, and whether the board decides to use that 2014 data in its mathematical modeling could decide how much health insurance premiums increase next year.
The Green Mountain Care Board’s lawyer, Judy Henkin, asked many of the questions on behalf of the board. Board members played a bigger role in Wednesday’s hearing, at times saying they had little control over the cost of health care.
Kaili Kuiper spoke on behalf of Vermont Legal Aid’s Office of the Health Care Advocate, which advocates for the public interest in these cases. She argued that the board should enforce the 3.7 percent increase its actuaries at Lewis and Ellis in Burlington recommended.
In her opening remarks, Kuiper referenced public comments from Wednesday and said health care costs are so high that they are “negatively impacting individuals, families, communities and small businesses in Vermont.”
“They described how health care costs are impeding their access to care, taking a huge chunk out of their budgets, and they’re asking what they will have to give up to afford future rate increases,” Kuiper said.
“Vermonters are living under a federal mandate that requires them to buy health insurance, yet they can’t simply shop around for a better deal because as individuals and small businesses, their only option is to purchase health insurance on the Vermont health exchange,” she said.
Karnedy said MVP is in a “kind of delicate” situation because it is arguing against the work of the board’s longtime actuaries at Lewis and Ellis.
“Kind of the elephant in the room (is that) L&E has been the board’s own expert and adviser for many years,” Karnedy said. “But in this case, in this particular year on this particular issue, MVP’s information is superior. Our opinion is superior.”
Kuiper countered that MVP must meet a burden of proof in order to raise prices 6.3 percent and said the insurer hasn’t met it. She said the Lewis and Ellis actuaries use a better methodology and the result of the methodology is more affordable for Vermonters.
Nicholas Totten, an agricultural worker in Johnson, was one of two members of the public who spoke at the end of the hearing. Totten said he and his spouse receive help from the federal government to pay for their health plan.
He said he and his spouse had to spend a total of eight hours on the phone with Vermont Health Connect, MVP and their pharmacy to sign up for Vermont Health Connect. He said it took a total of three weeks to finally get health insurance.
“Our doctors visits and our prescriptions in those weeks cannot be paid for,” Totten said. “We had no access to our medications at that time unless we were to pay out of pocket.”
“I cannot imagine that these rate hikes will see direct improvement of customer service or the expansion of what the plans cover,” he said. “Instead, it seems as the companies would like to buffer their executive pay grades as the already overly expensive health insurance plans cover no more services or prescriptions.”
Totten said that despite the help he and his spouse get from the federal government to pay for the plan, the deductibles “would still require us to go into debt to pay medical bills.” He added: “That is insolvent.”
Decisions on Vermont Health Connect insurance prices, which are quasi-judicial decisions, have historically been published in September.