Health Care

Regulators deny Blue Cross request to strike public comments


Green Mountain Care Board
Green Mountain Care Board members hear public comment on Blue Cross Blue Shield premium increases in July. Photo by Mike Dougherty/VTDigger

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.

Mike Fisher
Mike Fisher, the chief health care advocate for Vermont Legal Aid, testifies in front of the Legislature in 2017. Photo by Erin Mansfield/VTDigger

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.

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Erin Mansfield

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  • Cheryl Ganley

    Over 20% of my households gross income went towards premiums last year. That does not even take into count a delectable I must pay before my policy will even cover anything. My monthly mortgage is cheaper than my insurance premiums. We have a serious affordability issue.

  • Katharine Hikel MD

    Good for GMCB for promoting the patient-centered view; and thanks to the public commenters who provide essential cost-to-wage data. Allowing BCBSVT and hospitals to continue to raise revenue charges is like telling an 800-lb patient to ‘Just keep eating more’ instead of working on a reduction plan.

  • Nachman Avruch

    The increase applies to plans purchased through VT Health Connect; if you have a plan through your employer, the cost increase doesn’t apply to you.

  • Nachman Avruch

    An unfettered market doesn’t achieve public policy goals, like not having people die in the street for lack of health care.

  • Anne Wood

    It seems everything to do with health has risen out of control. When the average raise is a per cent or two now, how is the average person able to afford the rising costs? I wonder if BCBS still gets profit sharing(it wasn’t called that) every year still? If so, perhaps they could take a look at that as the top executives got some substantial amounts. Just a thought……