 Good afternoon, everyone. My name is Kevin Mullen, Chair of the Green Mountain Care Board, and I'd like to welcome everyone to a public comment period for the next two hours on the filings in the QHP, both the individual and small group markets by MVP and Blue Cross Blue Shield. And we're happy to hear from any member of the public on their concerns generally. The purpose of this is really focused on these QHP filings, but again I will not shut anyone down who starts to speak about something other than these filings. So just doing a check, do I have the court reporter, Sonny? Yes, hello, I'm here. Thank you, Sonny. And to do a check of all the board members, I'm actually going to ask if each of the board members could introduce themselves. I'm going in alphabetical order. Hi, my name is Jessica Holmes and I'm from Middlebury. My background is economics. I've been on the board for six years. Robin, you're muted. I think Robin is having issues with her speakers again. So I'm going to skip over Robin and we'll come back to her. Tom. Hi, so my name is Tom Pelham. I've been on the board for a little over three years. Native of Arlington, Vermont. I was the state's finance commissioner under Howard Dean and tax commissioner under Governor Douglas and a state representative representing Callis, Plainfield and Marshfield. Thank you, Tom. Robin, do we have your sound now? I don't know. Can you hear me? We can. All right. I just needed to pop out and pop back in. Robin Lunge, I've been on the board for almost five years and my background is in law and policy. I worked for Governor Shumlin and also for the Vermont General Assembly. Thank you, Maureen. Maureen Usoper and my background is in finance. I've been on the board for four and a half years and previously was chief financial officer of several companies. And as I indicated earlier, my name is Kevin Mullen. I live in Rutland, Vermont and my main background was in small business, but I did serve some time at the state house along with member Pelham. I spent four years in the house representing Rutland Town and 15 years in the Senate representing Rutland County. And I did notice that we have the healthcare advocate here and often he's very helpful for people who show up to these public hearings and can do some follow-up to assist if there's assist needed. And Mike, maybe you could just introduce yourself. Yeah, thanks, Chair Mullen. My name is Mike Fisher and the healthcare advocate. And I speak in this moment wholly in my role as running a helpline for Vermonters to access when they have challenges getting the care they need. And so I don't think that there's many members of the public here to testify as I look at the list. But I will go ahead anyway and just say if anybody here or anybody listening to this later has an issue getting the care you need and is looking for an advocate to help out, it's a service that's available to all Vermonters. And the number is 800-917-7787. Thank you. Thank you, Mike. And just to do a sound check, Christina McLaughlin, do we have any members of the public at the physical location? Not yet. Great. Well, you're coming through loud and clear. So if anyone does show up, we'll go from there. So at this point, what I'm going to ask if anyone has joined us using their computer or their phone with the Teams app, if they could click on the Raise Your Hand box. And after I go through those, if there are any, then I'll just open it up for anyone to speak if they're on their phone and just calling in. So I do see one hand raised, and that is really good. And I see that hand is Don George. I mean, I could raise my hand, but it's always here to listen to the public comment. Okay. For some reason, your hand goes raised. Okay. Is there any member of the public who wishes to offer public comment? Is there any member of the public who wishes to offer public comment? This would be a rare first. So I'm going to move away from the Teams platform, and if anybody is just on the phone, if they could speak up. In any event, we will keep this public comment forum open for the two-hour period that it was advertised. So would anybody wish to speak at this time? So I'm not hearing anyone. I plan on sitting here for the next two hours and just to make sure that if somebody gets out of work later than this time period that they have a chance. And Christine, I think it's important that we keep the physical location open for that full two-hour period as well. Yes, we'll do. I'm here with Susan Barrett. So we will let you know if anyone walks in, and I'll be by the computer to make sure that if someone speaks up, they're here. Okay. The rest of the board, it is a personal decision that you can make if you wish to sit around for the two hours. I think that Christina, Susan, and I can take the public comment, but that's up to you and we'll go from there. I knew of one person who had reached out to our office and asked for information about tonight that we gave the information to, but that's it. Kevin, somebody does have their hand raised. I see that now, and it looks like Andrea. Hi. Yes. Are you are you saying that nobody is here for public comment? I'm so glad I get to be the one. Well, we're going to keep it open till six o'clock no matter what, but we're glad that you're here, Andrea, and we look forward to listening to what you have to say. So whenever you're ready, proceed. And excuse me, this is the reporter. Could you just state your full name and spell it before you give your comment, please? Yes, it's Andrea Todd A-N-D-R-E-A-T-O-D-D. And if I'm the only one and there's time, I would love to ask you questions if that's possible too. We'll see how it goes. I did write some notes to myself and actually I want to put my camera so we can all see each other. There I am. Hi. So I'm self-employed and 100% self-employed and I'm a sole proprietor. And I've been doing that form of work for the last 10 years, but 10 years before that I was working up the courage to become self-employed without employer-provided healthcare. And I think I'm a large majority of people in Vermont that are only able to get healthcare through Vermont Health Connect. And so Vermont Health Insurance and getting health insurance has been one of the biggest barriers to being a sole proprietor and being self-employed. Mostly because of its expense. It is the biggest expense in my business is health insurance. But it's also a really big barrier. The Vermont Health Connect also provides a barrier to self-employed people because of the variability of our incomes and my income. And so while there is the benefit of sending a change of income form to the Vermont Health Connect, for me that changes so frequently that I would need to be doing my taxes essentially every month to be able to get a better read on what's an accurate unfair monthly premium payment. So I don't do that because I don't have the resources for the time and I end up filing taxes and then retroactively discovering that I either and this has happened to me was assessed a $4,000 fee for having not for having had a higher income or was you know got a sizable refund for the overpayment of having paid the high premium for the year. None of those things are comfortable. It's uncomfortable to pay the high premium rate all year and then to get the refund. And it's really uncomfortable and as a sole proprietor to get a huge assessment at the end of the year that I wasn't expecting. So this is the biggest expense and I would say the biggest stress for me as a business owner. Blue Cross Blue Shield has raised their rates I would say I think and I'm pretty certain I'm happy to be corrected on this but in the last three years it's been a 20% increase that I have seen and this current proposal is going to be over 20% push it well over 20% and to me that's just I wrote the word outrageous here but it's really hurtful that that is how high of the percentage that these rates continue to be because that's just extremely it's far greater than the cost of living. I mean it's it's such a huge increase and so when you as the board are looking at this as like a well it's only 4% or it's only 6% it is a huge percent over time and cumulatively that has a huge impact on me and to the point where I was going to get to this later but one of my one of what I'm constantly looking at is do I need to am I going to be better off not having health insurance because the expense for my business is so high and I could actually reinvest that money back into my business and roll the dice and hope that I'm healthy you know or do I continue to budget but not effectively because like I explained the the wavering variability of my of my income how do I budget for that you know the the system is broken I will say from from as a sole proprietor that is how I feel for health for health insurance and so the other piece of this the rate increase that I wanted to address is that last year with COVID I paid a full premium price for my health insurance and couldn't access it essentially everybody was inside we were able nobody was using health care and so I feel like Blue Cross Blue Shield got my money all year last year and didn't have to give me anything they got their raise last year that's how I view it and so I really don't I don't think that I don't think there should be any any increase for Blue Cross Blue Shield at all and so I guess my my closing statement is that I think that this system disadvantages discourages those of us making a living out of our on our own and that this rate really disrespects Vermont's proprietors that are contributing to the economy and like I said are are leaving us debating like how can we should we or how can we make this work so that's that's sort of the the grateful for the opportunity to share these thoughts that have been mulling over my mind for the last 10 20 years as I've been trying to keep myself insured and I'm hopeful that you can see me as a human being and that when you're raising these rates even a small percentage you're making it so much harder for me to earn a living and stay living in Vermont and get and get contribute to my state that I love and my kind of question if I if I'm able to ask a question I have been really curious to know what health care plans the Green Mountain Care Board members have and so if you would and it and how much you pay a month for your health insurance because I don't I would like to have a better sense of if you actually know what this system involves so if I can ask that I would love to answer questions that you have to me but I would love to hear that from you so each of the board members is actually eligible for because we are employed by the state of Vermont is eligible for the state plan and so we contribute 20 percent my background is as a small business owner so I know exactly where you're coming from and what you're talking about because for years it was always trying to figure out how do you keep that expense down and I'm old enough that I actually predate some of the changes in the law that in some ways benefited me because they were discriminatory so that a male paid less than a female and age paid you know a younger person paid less than an older person those laws have all changed and tried to create some equity within the system and and I'm taking it from your comments and I'm only going on like this we normally would never do this in a in a public session but since there's nobody else that has offered to speak at this point I just want to keep this conversation going because I take from your comments that you're buying in the individual market that you're the only person in your business and because the small group that the company that you mentioned that you're with they've actually filed for a rate decrease on the individual side it is an increase but there's a built-in problematic problem this year in that there were changes made at the federal level and the ARPA rules and laws that were passed at the federal level are increasing the subsidies that you can receive as an individual and so the state of Vermont was one of those few states the vast majority of states did not have emerged market so that the individual market was separate than the small group market but Vermont had made a decision years ago to have emerged market to try to get to some sort of scale in a very small state which is next to impossible to ever reach scale but to get to some type of scale to offer an affordable insurance product and so this year the cutoff levels for the income were much lower in the past this year they go up to 400 percent of the poverty level and you may get some additional help this year that could be quite beneficial to you and I just want to make sure that shop there I'm so grateful that that's happened and I think Mike I spoke with you on the phone that you know that's that's going to make a huge difference in my savings yes I am and this is sort of my point is about being a individual and a sole proprietor there's so many of us I think of like the guys that own Christmas tree farms you know that just work for themselves and I'm an educator a professional educator a learning specialist private learning specialist there are a lot of us that can't buy into that small group and so that's why I'm very grateful that I can actually talk to you today because I think that we get forgotten because that individual price is staggering and I still I just so just to give you a little more details like before I did the change of income like I explained that at the end of the year I finally did my taxes and did the change of income so before that I did I was paying like the full price the $740 a month for just my premium and that was with the three thousand three and a half thousand dollar deductible but oops by the way you still have to pay eight thousand dollars out of pocket expense so the numbers that I want you to hear from me the reason I want you to hear that is if you're in the health care the state's health care plan you don't understand that and see that because that's like they're paying that for you you're paying into it but it's cheaper because you're conglomerated into a group but as a single person trying to make this business work I'm looking at over that was over ten thousand dollars and that I need to budget for myself that's like money that I can't invest in my home a car I can't buy it's a student loan I can't pay off and the ARPA funds are awesome but those are temporary man sir I mean they're like that's I don't I don't think that that I mean that would be amazing if I continued to have those those benefits but I know how the system is cyclical and I don't expect that that's going to be the case but the rate increase for Blue Cross Blue Shield will still be there when those ARPA funds are gone and so I think that I understand what you're saying and I think that I and I want you to understand that I have spent a lot of time trying to understand what's happening and again as a sole proprietor I'm also the human resources department that needs to understand what's happening and so again that when when I talk to a Vermont Health Connect person and they say well if you just filled out the a more regular change of income I'm like that is a lot of work that is a lot of work and so I'm glad that I'm the only one and I can have this conversation with you today so I'm great I'm grateful. Any program that is income based is problematic when I was in the legislature one of my neighbors is a farmer and actually qualified for the at the time what was I think it was called VHAP and the problem was they were doing the income calculations by quarter and as you can imagine a farm has all its income for the vast majority of it in one time of the year and so it was always problematic for that family and I was always trying to advocate for them and so I do understand exactly what you're saying I do think that none of us have a crystal ball we don't know what will happen with these ARPA you know enhanced premium credits I've got to believe that a lot of people are going to be very upset if they're taking an old taken away but we did testify before the legislature and made it very clear that you know it made sense to unmerge the markets but it could also make sense to re-merge them again if that were to happen if if what your your worst fear is that you know they're going to take away those enhanced credits then then hopefully the state of Vermont will re-merge the markets. Yeah thank you for for explaining explaining that too and and honestly it's just a treat what I love about Vermont I grew up here and it's it's really nice to be able to have an opportunity to share this with you and and while I'm not in person it's the best next best thing and I'm in Berlin so thank you. Did you want to share what your business is? Oh yes I'm kind of a learning I'm a learning specialist and and do instruction and executive functioning and time management. And Andrea I'm one of the board members now but I'm finishing in September so I will be joining those ranks that are going to be going on there and my husband's self-employed we won't get any of the benefits so when these when we're talking about these splits and like MVP going up by 17% everyone's saying well most of the people won't feel that I'm like oh really it's like no some people do feel that and so I'll feel it. Yeah and I didn't mention this but I think like I've thought this for a long time and since I can keep talking I will. To reduce the barriers to entrepreneurs or to self-employed people is a really is a way to boost economic growth I think it's a huge I think of like you're taking this leap I'm sorry I don't know your name but you're taking this leap which is going to be which is terrifying that I've done it myself you're like hoping that it's going to work out and you're also hoping that you don't get sick you know and I think that if there were less barriers for people who are and Vermont is special that way there are so many of us that are got maybe they're got side hustles or their side hustle becomes their main hustle that if that wasn't a barrier we would be we would be bringing a lot more creativity and a lot more business development to to the state of Vermont and I know Phil Scott is pro business but I wish he was a little more pro business in healthcare. Well we won't get into any politics today. I'm happy to answer any other questions or experiences too while I'm here. I was just going to chime in and say I have some friends who are in a similar boat and they experience that same challenge with their business in terms of the income fluctuations that is driven by the federal tax credit so it's not state law it's federal law so I don't have a lot of sort of hope that that potentially could change since it's the IRS driving it but certainly you could communicate your challenges with our congressional delegation. I'm sure that they'd be very interested in hearing about any of those components that are federal. Great thank you yeah I didn't think of that but it's not often that there's this in public invitation to talk to the Greeks but I thought I could start here. Well we're glad you're here because otherwise we'd be twiddling our thumbs so it's great to have a conversation. I can share another anecdote from a friend who's a sole proprietor with a family and he has shared with me the exponentially you know $2,000 a month premiums that he needs to pay for his family and that that continues to be a challenging a business burden for him in a significant way you know two two children a wife and it's it's not it's something that we talk about all the time like how are you how are you making that work? Yeah okay well I I'm so glad I was the only one so far I mean I guess you might have people until six like I wonder what you're gonna what are you gonna do until six o'clock? Hang it out. Our friend, we're used to large crowds at these so this is a rarity but it's also the first time we've ever had a negative rate filing and last year was remote as well and I was very concerned about last year but we had a good turnout so I assumed that we would have again this year but you know it it is the middle of summer and it's I do think we also had no public comment on either of the meetings that we had so that was correct we thought we thought they would be holding out for tonight. Oh so the previous meetings haven't had any feet any way in either Wow well of course people had to hang out till eight from eight till five five thirty every day so that might have been a you may have dropped off but we didn't have any comments we were hoping they were coming tonight. It gave the health care an opportunity to tell us about how we pulled a snake out of his water heater. Well I will say just another plug for the cell we're always working but that's why we tried to bridge this so that with the four to six period if if somebody worked till five they could still show up later that type of thing it's it's always picking the best times if you do it's seven to nine some people work nights if you do it during the daytime then people say that well how could anybody show up so it's it's difficult well I think that with the remote capabilities now that it it is easier for someone who in the past would have to go to a physical location it's a little bit easier to be able to just log in and and share their comments. That's that's a hundred percent why I'm able to be here today so thank you. We're trying to figure out a way as we go back to in-person meetings to be able to have that component where people could still participate remotely and be able to be a part of the meeting but still have that physical presence and and we haven't quite figured that all out yet. Well I work with students and I'm trying to figure out what what are people going to be most comfortable with and I I think both options are what people are going to be most comfortable with. Well I will I will let you carry on your meeting and thank you for the time that I've been able to share and I'll just say please don't raise those rates for the individuals for Blue Cross one more time. Thank you Andrea. Thank you have a good night. Is there any other member of the public who wishes to comment? Walter do you do you wish to comment? Well I was just as I listened to Andrea I was really just thinking of something that Deb Richter said years ago and I think it's time and again it's a repeat and we ask this every year as the rates go up and the rates go down as Andrea is right you know the ARPA funds and all that and I think it's time to ask ourselves as a group as a whole does Blue Cross exist for us or do we exist for Blue Cross? And I think that that's something because next year we're going to have the same rate filing and rates are going to go up you know umpteen percent and then the board will have to figure out what your mantras can handle or what we can't handle and MVP will be the same and Thigna will be the same so we're going to go through the whole charade over again. So I'm just wondering and just putting that out there kind of for all of us involved in this to think about because at bottom that's in a sense what's going on as Andrea so you know rightly said the eight thousand dollars the three thousand deductible true federal policies all that but we I think we've reached that point we really can't take too much more small businesses working people can't take too much more especially you know since our as I've said before and Robin has repeated you know and he's smiling and I'm smiling at it because we both laugh about it but you know our wages might go up 50 cents a year I got a 50 cent raise this year and that was it and that's the first raise I've had in two years you know so it's kind of at that point and how much can we bear of six seven eight nine ten percent increase along with all the deductibles and copays and the plans that keep changing every year you know and they get more confusing as we go along so luckily I'm I actually lived to make it to Medicare so a lot of it I'm kind of I've reached that plateau where I'm still I'm beyond a lot of that the monthly plans but I'm still affected by it you know because the supplement plans will go up they'll you know they'll inevitably go up the part the part D plan has gone up and that faithfully rises every year so I I don't wonder and I know the board can't do much except fill the holes if possible because it's a legislative prerogative and it's a legislature that has to do it but I think it's something we should think about is do we exist for Blue Cross or does Blue Cross exist to benefit us and at some point we have to ask ourselves is do we really need an insurance company to do something we could do ourselves and that just kind of got into my mind as I was listening to Andrea so I know that you know the board can't do anything about this question could could I just pause for one moment I've I've got to close the window there's suddenly a lot of noise outside just one second please somebody always decides to do some sort of mowing during these things yeah so I've noticed that too Sonny whenever we have a meeting that the neighbor decides it was weed whacking or is mowing yes it's very never fails it's so nice I finally got to have the windows open but anyway I'm sorry I didn't mean to interrupt go on please oh I'm pretty much my my tirade is pretty much done okay is there anyone else in the public who wishes to speak at this time we two of us wow yeah it's a different year yeah that's again mid summer I just happened to have the day off which is the only reason I could be here but I thought you just missed us Walter always do Jessica you notice I'm here faithfully every Wednesday I know and we very much I can't live without my green mountain care board fix what was that they they call that an addiction right I'm sorry Walter but maybe you need something else a little bit more exciting in your life now what could be more exciting than the green mountain care board listening to all this about one care and charts and graphs and markets what on earth could be more exciting than that all the experience I've had in the world has come down to this does anyone have any good stories they wish to share Eric I see you just popped on did you have a good story to tell us now not really Kevin I am I am moving to Plainfield which I'm pretty excited about found an old lefty who is selling us a house at private sale pre-covid prices pretty excited about that but I was just thinking about the public comment as you were talking and then like my stress levels are increasing because it's like oh my god look at how much ground is going to have to we're going to have to make up next year right at first I was happy because it's like oh these web tools actually worked and then that we were putting out and then I was like oh my god we've lost all the momentum next year so getting folks to do public comment it's going to be uh quite the challenge well hopefully we're all in person next year Eric would be nice that it makes sense for then we we really do need to figure out how to do it both ways marine and marine and marine and her husband will be here next year protesting exactly telling you all the pain Kevin I will share that I I went to a Lincoln select board meeting recently and um and they had this slick little camera that sat in the middle of the room that turned and focused on each of the members of the of the select board and there was a screen you know for remote it actually worked so maybe um Susan Barrett since you're in the office maybe you could call the town manager of Lincoln and ask what that technology is and how much it cost don't forget my budget has been level funded for the last four years I'm not sure Sonny needed to put that all on the record Kevin is excited to be his executive director I was actually going to say um it probably makes sense probably makes sense for us to be off the record until someone else appears okay then I won't have strain to hear over the lawn mower as much as you can open your window what town was it like town of Lincoln yes town of Lincoln Elena I'll let them know I know you maybe you should check and make sure that's a good thing for us I'm sure they have a good barbecue there the fireman's barbecue we like to go to that one sometimes I've only been through Lincoln nothing about it so hi everybody this is Kathy Colton and if we're off the record just that that's meeting facilitation technology with that camera I believe it's called an owl and I think our information systems manager has looked into that so um Susan I'll ask Bill to give you a call if he has that information because I think we had kind of considered it at one point for some of the you know presentations and telehealth office hours uh I think it was a little bit of a cost for improvement but it's some pretty jazzy technology to help facilitate meeting great you're already making me nervous when you say cost prohibitive level funded budget five years is it five years or six years I think it's five years yeah but think of all your saving and travel expenses yeah um but you know the even for um the hearings and everything we have saved and all the and the environment as well right right Mike Fisher yeah we'll talk more we have it we have a we have a uh we we put something on the calendar right Mike actually we we haven't we should talk about that hey we made it the two hours we did and we're at that time so I'm going to do one more last shout out in case any member of the public wishes to offer public comment before we close this meeting hearing none I would entertain a motion to adjourn so moved second I guess all those in favor signify by saying aye aye those opposed but the record show is unanimous vote and thank you everyone it was a nice conversation for the last two hours and uh next year hopefully we're in person and we have a little bit more turnout so and I thought I thought our first witness was great that was great she should have stuck around right it's not it's not quantity it's quality yep thanks guys bye guys