 This is our look at the health care marketplace policy changes. This is for permanent open enrollment for subsidies for eligible Vermonters. So, Sean, I've got you first. Is that the way it should go? Are you going to explain this? That sounds great. I'm happy to do that. Sean, Sean, she has senior policy and implementation analyst from the Department of Vermont Health Access. Thank you all for your time. Looking forward to the conversation. Sean, is this like an official request from the state? This I think is more, we're more here. I think out of, I think, partnership and cooperation, this particular rule that we'll be discussing when we reached out in the fall, we weren't sure whether it needed to be dealt with in statute or rule. We've since gotten clarification from the feds that it's fine to deal with in the rulemaking process. So, we wanted to share that with this committee, obviously. Probably best if we understand, because I'm going to get a thing asking me if it complies with legislative intent. It'd be good to know that. All right. Absolutely. So, I think to take a step back, I think most of the committee is familiar with our health insurance marketplace from Vermont Health Connect at a high level. But just to set the stage, open enrollment is the period we're in right now. In past years, it ran through December 15th. This year, the feds extended it through January 15th and Vermont followed suit. So, it runs through this Saturday. Open enrollment is the time that anybody can sign up for health and dental plans through the marketplace. Okay. This is. Yeah. Yeah. Sorry. The reason why, under the Affordable Care Act, they set up a period of open enrollment and not have people be able to sign up any time of year was due to adverse selection. I caught on on Friday's session, you were talking about adverse selection. So, good timing to be all primed on that front. Well, I'm having chest pain, so I think I'll go get health insurance scenario. Exactly. Yeah. The idea that if you're feeling healthy, why spend money on health insurance, wait until you get sick and then sign up for health insurance then. So, in order to prevent that, is why under the Affordable Care Act, they set up open enrollment period, the time of year you could sign up. But outside of open enrollment, there are going to be times and occasions where you need health insurance, and they're not trying to play games, they're not trying to only get the health insurance when they need it. So, we have special enrollment periods. Usually, special enrollment periods have been tied to life events. For example, if you change jobs and your old job offered employer-sponsored insurance and your new job doesn't, that would be a life event that would give you 60 days to be able to enroll in a plan through the marketplace. Similarly, if you move into the state of Vermont, you obviously wouldn't have had, you move in in April, you obviously wouldn't have had Vermont health insurance during an open enrollment time. Or, if you're on Medicaid and you're found ineligible for Medicaid, you would likewise have 60 days to enroll in a qualified health plan. Now, what's different about this particular special enrollment period is that it wouldn't be tied to a life event per se. It would be tied to an income level. The federal government is looking at, or is for this year moving, to have a permanent special enrollment period for people whose income is up to 150 percent of the federal poverty level. Medicaid covers you up to 138 percent of the federal poverty level in most cases. So they were looking at people whose income is just over Medicaid levels to be able to come in. Their rationale for that was, in large part, that the subsidies that people who are just over the Medicaid level can get, particularly under the American Rescue Plan. Are so high that you can have that option of getting zero premium health plans. So if you're not signed up for health insurance, it's not because you're trying to save money by not buying a plan, because you could get a zero premium plan. And that takes care of adverse selection there. That was the federal government's rationale. They're adopting that for the federal marketplace, but states that run their own health insurance marketplace, as Vermont does, has the discretion of whether they want to follow suit with this rule and if they want to adopt it on a different timeline or different parameters. In Vermont, we think it would be better to go for, we're looking at a 200 percent upper threshold rather than 150 percent of the federal poverty level. So 200 percent equates to an individual earning up to about $25,000. Up to about $18,000 you'd be on Medicaid. And so rather than being that just 18 to 20,000 or so, it gives you 18 to 25,000. Family of four, 200 percent of the federal poverty level is up to just over $50,000 income. And the rationale here are a few fold. One in Vermont, because we have the additional state subsidy, the Vermont premium assistance, that means that people at a slightly higher income can still get a zero premium plan, a zero premium enhanced over plan with low out-of-pocket costs up to closer to 200 percent of the federal poverty level, whereas nationally with just the federal tax credit, it would be around 150 percent. So that adverse election, actually we can go higher in Vermont, number one. Number two, currently and for the last almost two years under this public health emergency, we haven't been running Medicaid redeterminations. We're not allowed to for the federal government leaving people on Medicaid, even if they would be income or otherwise ineligible. But when the public health emergency ends, we'll be restarting those redeterminations. During those times, there's typically a lot of normal times, which I'm not sure will be a normal time this year, but as we approach normal and get back to redeterminations, there is a lot of churn as people's income is not constantly at Medicaid levels. You have people go on Medicaid for a few months then they go off Medicaid when they're no longer eligible, they go on to a qualified health plan back and forth. This measure would allow people who go off Medicaid, maybe if they've moved and they don't get the mail or the redetermination letters or if they don't open their mail. As is often the case, they find out that they don't have insurance when they go to a provider for their annual checkup. If they qualify for Medicaid, they can roll right back on. If they don't in the past, they haven't been able to. This will allow people even with income significantly more than that Medicaid level to come right in and get that health plan. So that's the gist of the proposal. We believe it would be good for Vermonters, help increase the number of Vermonters who have access to health insurance. We don't think it'll be an adverse selection issue for the reasons I said. And it also would help because it would help the state's healthcare system draw down more federal dollars because these folks are the folks that draw down the most federal premium tax credits. Okay, Senator, any questions? Yeah, thank you, Madam Chair. And thank you, Mr. Sheehan, for your testimony. Just a question. It's at the start of your testimony, you made the distinction between an open enrollment period and a special enrollment period. And you said essentially, Debo was making the recommendation to allow, based on this new federal allowance, to allow a special enrollment period for people up to 200% of poverty. Is there a period or is it just all year round would be a special enrollment period? Yeah, that's a great question, Senator Hardy. And thank you for clarifying that. Senate special enrollment period is probably, maybe not the greatest term for that reason because the other special enrollment periods, as I mentioned, are tied to life events, generally are a 60-day finite window. This, I guess you could call this an income-based open enrollment, permanent open enrollment period, would maybe be another way of calling it. The Feds are calling it a year-round special enrollment period, but essentially, yeah. Every day is a special day. Every day is a special day, right? Yeah, the idea being that it's tied to income, rather than, so if your income goes above 200%, it's no longer a special day for you. But it would be, as I may not have been as clear as well as this is open enrollment period is something that's specific to the private insurance and to the qualified health plans on the marketplace as distinct from Medicaid. If your income is at a Medicaid eligible level, you can sign up at any time of year. So this is sort of bridging that gap, making a bridge between Medicaid and qualified health plans in the sense of making these folks who have an income in between Medicaid and higher qualified health plans, allowing them to enroll any time of year similar to way folks who are eligible for Medicaid can. Okay, if that makes sense. Thank you for that clarification. You're welcome. Okay, any other questions at this point? Okay, we're gonna move on to Michael Fisher. I'm sure you hate this, Michael. What could I hate about this, Senator? Mike Fisher, healthcare advocate. Thank you for taking this time to understand this. And I think this is gonna be a moment of broad agreement, I hope. I think everything that Diva just said is something that the healthcare advocates can, office can get broadly behind. We think this is a good change and a change that will really help out a set of remunters. And just a brief reminder that, no surprise here, this is a particularly difficult time for families. And the coming transition, currently there's no redeterminations happening in Medicaid, that's gonna change and families are not going to be used to that. So we think this flexibility will be, again, for those folks who are under 200% of the federal poverty level, who have precious few options, we think this will be a good option for them. And it will certainly provide a little bit of good news for my advocates as they're helping people maneuver through this system. So a brief to keep with your, keeping it brief to keep with your timeline, we support this. Questions for Michael? Okay, we'll move on to Sarah Teach-Out. Good afternoon, Chair Cummings and the rest of the committee. Sarah Teach-Out with Blue Cross and Blue Shield of Vermont. And I'm happy to tell you that Blue Cross supports expanding the special enrollment period for low-income families. We believe this will be quite meaningful to the few families that it'll apply to every year and will help with health equity in the state of Vermont. So we're happy to support it. I think I don't need to get into any of the arguments because Sean was quite good at explaining to you what this does. And I think our experience with the COVID-19 special enrollment periods gave us a lot of comfort that this will have a pretty minimal impact on the marketplace. So happy to answer questions. If you have them, I'm just here in support. Wow. This is moving along. Okay, Chuck Storrow. Good afternoon, committee. Chuck Storrow, Lienine Public Affairs here on behalf of MVP Healthcare. And, you know, for all the reasons that the previous witnesses have explained MVP also supports Divas proposal. Okay, any questions, Senator Hardy? This is not a question for Chuck, although thank you, Chuck and Sarah. It's actually, I think for Sean, maybe. Okay. Are you, Sean, are you still there? Are you all, Deva is proposing a rule? Is that my understanding? Is that correct? Or is there something we need to do? Yeah, it's a piece that we can handle through the rulemaking process. I think we wanted to involve the legislature for feedback. And obviously there's a number of ways it could go, but it would be consistent to do it through the rulemaking process in Elkhari. We're prepared to do that. Okay, great. I think when this started, if I understood you, Sean, it wasn't clear that it could go through rules. That's correct. And there were a bunch of emails coming out saying, you know, we wanna do this. So we put it on the agenda so that we all understand it. And if anyone doesn't like it, they had a chance to say they didn't like it. Okay, so when that little sheet of paper comes in from Demis, I can tell, or Charlene, I can tell her that we're all happy. All right, thank you, everyone. This has been helpful. Committee, we are way ahead of schedule. And I am not sure where to go with this, even though I thought I was leaving early trying to get out of here at five minutes of four. We have a whole extra hour, which I'm sure none of you would mind having. And they're coming. Yes. Pardon me, this is Faith. Would you like to do governors appointees? Have we just got them to hand out? I sent them to you. You sent them to me. All right, let me find my emails. Do you know approximately when you sent them to me? No, that's next week's agenda. Hey, I'll resend it. I sent it yesterday. Yeah, oh, well, since I haven't gotten much time to work on my emails, you're probably a hundred down in here. I just sent it. You just sent it. All right, I've still got Andrew as my top email, but it is updating. Oh, here it is. Okay. I think Senator Brock knows all the nominees. Okay, we'll just let him do it. Okay, the first one I've got is Riley Allen to the Public Utility Commission. This Senator Bray, you wanna do Riley? Sure, I'll do Riley for a long time. I've known him too. The second one is Peter Gregory of Heartland to the State Infrastructure Bank Board. Have I got anybody? Senator McSarachan, you'll do that one. Faith, you're writing this down. And did they happen to send us contact information this year, or like every year, do we have to ask for it? I'm writing it down and I have the contact information for you. Okay, great, so you can get that out to us. We're making progress after 10 years. I've got Karen Hale of Lindenville to the Vermont Economic Development Authority. Senator Hardy, you wanna take that one? Carolyn Carpenter of Salisbury of the Vermont Economic Development Authority. You'll do that, okay. Yes, I know, Carolyn, thank you. I'll take her. Okay. That's it. All right, we should be getting more. And I'm assuming we finished ours up. If I remember, we got them being just under the gun last year. So- A couple that were late, but I think we got them done during a special session. Okay, we can double check on that, but it's probably best if we do them early. Cause, yeah, this year, I am just anticipating things being really hard and it's hard because a lot of things are not gelling yet. We are going to get in to the waiting study. We're still, we're waiting on the governor's budget address because we understand there'll be several more tax proposals in there other than the ones we got in the property tax. And we got a bill today to make federal civil servants, pensions, tax-free. I know about anybody else, but I would expect that the state employees might be a little upset if we did that for the feds and not for them. And right now, I'm not sure I want to touch anything that has to do with state or, employees, public employees and retirement. We have a touchy balance right now. Senator Bray. Yeah, you know, I mean, this is an ongoing challenge, right? We have military pensions. So then federal pensions, then it could be state employee pensions. And the irony is that I get it. We may not score well on some sort of, sheet compared to some other states that provide for exemptions, but I think the reality is for most of our constituents, they're not, they are less well off than the people receiving these payments. So every time we do this or consider doing this, it's to the detriment, I think of sort of the average Vermonter who's going to be asked to pick up the slack. And now maybe we're, you know, some people make that kind of like the remote recruitment of workers. Maybe someone will tell me it's cash flow positive to give these exemptions, but I don't know. There's no work retirement and I don't know that federal civil servants retire early and work afterwards. Senator Brock. Well, I would repeat what I've said, I think in prior years while this has been on the table, I think that military retirement is different. I think that there is a, in the public, a belief that this is a wise thing to do. We're one of only three states that does not do that. And we're losing labor. And if we look at this as an economic development tool, and I hope to be able when I hope this comes off the wall to at least have a brief discussion about it, to be able to provide some facts and figures that show that this is in fact a revenue positive thing in a state where we have this severe shortage of workers. Okay. I think we did establish with the tax commissioner, however, that most of these exemptions went in in the early fifties when we were all feeling very patriotic for our returning soldiers. However, the bill didn't come due for another 20 years. Vermont did a deduction on your home value, a $2,000 deduction, which was significant when homes were selling for 20, 15, 13, $10,000 a year in that timeframe. And that exemption when it didn't go away, it's just you usually do better under act 60 paying on your income rather than taking that deduction. But it isn't like Vermont did nothing. We put our money where our mouth was early on and we did do something. So I'm not going to feel guilty. And we can move forward. I just have a hard time. We have police officers that have to retire at 55. And we're not exam. I think most firefighters retire early. And we are not doing anything for their pensions. And they do serve us. So. Senator Hardy. How do we get here? I moved around. I don't know. I'm just following our course of discussion. Because you mentioned a bill and then it mentioned. But I just wanted to weigh in and say, I agree with you in that center, Brock. I believe we asked the tax commissioner for data last year. And he didn't have any that supported the notion that it was. That it was both a. Draw for retired military retirees or an economic benefit for the state there. He had no data. So maybe. Had no data. And that's what I hope to be able to present to you as data. Okay. Well, if you have it, I would be interested in seeing it. We will have the tax commissioner in. Once all the governor's proposals are out. And we will. And there's a few more floating around. So we're going to take a look at all of them. Before plus. I'm trying to tie down. What if I, what our revenue. What our traditional, they call it the alligator jar, but the traditional track between our base revenues and our base expenses. And they're waiting. They want to see the new Tom. They want to see the new tax proposals. They want to see the new tax proposals. They want to see the forecast and they want to see. All the governor's tax proposals. But as we are going to start with the. Income. Property. Yeah. Property tax based on income. School. An income based school funding. But I'm trying to get all that information out there. I'm trying to get as many of the newer bills on and out. I'd like to get Rige either out or decide. We're not putting it out as soon as possible. So we can move forward. We can move forward. We can move forward. But it's just getting it all together at this point. We obviously have a lot of new people. At joint fiscal. So. That's. Part of what. We're struggling with, with the agenda. So I'm going to try and get as many of the newer bills on and out so we can move forward. So Senator Hardy. Yeah, I just wanted to say tomorrow I'm going to be briefly talking to you all about the pupil waiting. Stuff and what, what. Your thoughts are and. What information you need. So if you can be thinking about that about what you're going to do with. The budget and the costs and the weights or cost equity payments. That part of the program. The poverty measure. And the. The evaluation mechanism. The ELL grants is starting in the. Education committee. And then would probably come over to us when they're done with it, just so you know that. But if you can think about it, you all need. Senator Brock and I spent six months on this and so I'm sure we'd both rather not go over every single thing again, but we want to make sure that you have the information you need to understand the proposal in a way to the Lord. Yeah, this one is momentous. I mean, this is a once we haven't looked at weights and I don't know, not in my time in the Senate. So that means it's been a lifetime. They've preceded act 60. They've been in since oh, yeah, formula. So so they may even precede Senator McDonald. So we will be getting all the information we can on that one. And then kind of as a discussion out of that is is the property tax. So we'll be looking at that. The other thing I'm sure they're still trying to calculate is the impact on the now that we seem to have an agreement on pensions, finding out what that impact is on the ed fund. So we may have less of a surplus than we thought we had. And then depending on what we do on waiting that could have an impact on the ed fund. And so we're going to need to get all of that out there. Because at some point, we're going to set a yield or a tax rate. I still can't understand the yield. We're going to set a tax rate. At some point this year, Senator Pearson. Madam Chair, when do we get the updated forecast? Tom Kovett is coming in. This week or next week, Faith, I think it's Friday. It's Friday. And there's an eboard meeting in the morning. We'll set the revenue figures for the budget. And then Tom Kovett is coming in. And weeks ago, I got an announcement that maybe it's just legislative, maybe it's committee chairs can meet with him at eight o'clock in the morning. But we will have him in after the eboard to walk us through all his economic projections and where he thinks things will be going. He usually doesn't do a formal five-year forecast, but definitely is part of this. He's looking at what's likely to happen. And I think right now where we seem to be swimming in federal money, the question is what is going to happen? Where are we when the federal money goes away? Given the Build Back Better bills progress in Congress, I'm not going to start spending any major federal logistics, except maybe on roads and bridges, which will make transportation very happy. But I think we've probably gotten the big slug. Hopefully the economy will get a slug from infrastructure, but we will find that out.