 Okay, so 1 o'clock, so I'll call to order the Green Mountain care boards meeting of February 8, 2023. Thank you everyone for joining us today. We have 1 primary agenda topic, which is the 2024 standard qualified health plan designs and a potential vote. Before we get there, I want to hope that everyone's safe and well. I know there's been some issues at the schools and I hope that everyone's children are safe and doing well. I know a lot of us have young kids, and so I just wanted to share that sentiment. I'll turn it to Susan Barrett for the executive director's report and then we'll take up the minutes from January 1st. Thank you, Mr. Chair. A few brief announcements are in addition to our regularly scheduled meetings on Wednesdays at 1 p.m. next week we have a general primary care advisory group meeting. That starts at 5 p.m. It is via teams with the physical location for those who can't access teams at 144 State Street in Montpelier. I also wanted to thank our general advisory group for meeting this Monday. I believe that it was. We had a very robust discussion on some of the work that the board is doing with AHS on Act 167 of 2022. We don't have any public comment periods open except for the ongoing public comment where we're accepting any public comment regarding the next all-payer model agreement. We share those with AHS and the governor's office as they are leading the implementation of the current all-payer model and negotiations on a potential next model. So with that, I will turn it back to you, Mr. Chair. Thank you. We'll turn to the minutes from February 1st 2023. Is there a motion to approve the minutes? I move we approve the minutes from February 1st 2023. Second. So definitively, I like it. These must be really great minutes this week. All those in favor, please say aye. Aye. Aye. Aye. And the vote is unanimous and the minutes are approved. With that, we'll turn it over to Dana Hulahan in connection with the 2024 standard qualified health plan designs. Mr. Hulahan, how are you? Nice to see you. Good afternoon. Thank you for having us back. So today we have prepared, I would say, we wakely at our direction has prepared some contextual information that we thought would be helpful for the board. This doesn't introduce any new proposals. It's really just providing a little bit more color around some of the segments of the presentation that could just use a bit more detail. So we're going to start with that and then come back to me for an overview of the January 2023 enrollment as it looks on the exchange. So, Darren or Julie, I'd like to turn to you. Yeah, could you switch me to our presenter? I know we had to do that last week too, so I couldn't share my screen. Apologies, I've already done that. Yeah, no problem. Raise your name. Perfect. That worked. Thank you. Oh, thank you. Someone did it. Yeah, so just wanted to kind of touch on a few things from last week where we felt like we probably shouldn't include a little more detail to provide some context to kind of what was changing with the AB calculator and what made it different this year versus kind of a typical year and how that kind of impacted decision making when putting the standard plan designs together both this year and kind of going forward and how we think about those things. So just a quick outline this shouldn't take long at all. So going back to the 2024 federal AB calculator with the changes to the logic. I don't think I spent enough time on this. So the way the calculator was set up in the past was that if a plan had say a $3,000 deductible and a $50 copay on specialist office visits with a deductible not applying, it would count every single specialist office visit copay towards that deductible, not just towards the loop. So if you had four specialist office visits and then a really big inpatient stay, you pay $200 of copays and then $2,800 of deductible. Whereas in practice, you know, every plan I've ever seen would not accrue those copays towards the deductible. You pay your $200 of copays, you'd have your stay, you'd pay $300 deductible. Did this change grow, let me see, this change increase actuarial values as calculated in the calculator because they're accruing all these copays towards deductibles, which means it's your deductible sooner, it's a richer plan. So this year when they kind of corrected that, so that the AB calculator was in line with, you know, the way pretty much every plan actually adjudicates that dropped AB calculator values down. You know, in some cases substantially depending on the plan that kind of gave us this one year break and like the steady uptick of, you know, a calculated ABs and see. Yeah, I'll send some per second. And that uptick is just due to kind of the trend in claims. So as we mentioned, you know, this year they're applying 5% medical training, 8% pharmaceutical training. So every year these claims kind of take up and up and up, you know, $3,000 deductible gets more and more rich because more and more claims over that $3,000 trend. So there's kind of that steady ratcheting up of actuarial values with the same plan design. This year we kind of get that one year break in it because of that change in logic. So that change, it's not anything that's impacting, you know, standard plan designs, anything that's impacting how anything would actually be implemented on the Vermont side. It's just the logic in the schedule calculator has changed, which gave us a little more wiggle room kind of on a one time basis. Okay, so then, so going back to kind of this slide of what we're actually seeing. So, you know, gold stayed mostly the same silver we saw that decrease. You know, we had a bunch of plans that change kind of differently that we would normally impact. So we wanted to put a slide together of kind of what we what we normally actually see. So we've got the plans broken down off to the left here, you know, min and max probably not as impactful, but this is kind of the average year over year change we typically see an AB for each of these plans. You know, this is going back to, I want to say, 2016. So we have a substantial amount of years of AB calculator updates. So on average, every year they release a new calculator, the gold plan design goes up 1.3% before we change anything. And if that bumps it up past that 82% now it's out of compliance and we have to reduce benefits to get it back into compliance. You know, the silver deductible plan for whatever reason seems to be especially impacted by these kind of year over year updates, an average change of almost 1.7%. So again, every year you you have this really big ratcheting effect that's happening that we have to counteractive plan designs. You know, this year, the actual change we saw, you know, was obviously dramatically different for some of these plans, you know, so much deductible that plan has a lot of copays. So this change was especially impactful, you know, the silver HD HP, you know, got a lot of copays mostly just deductible loop. Didn't really change the story at all on that one or the Bronx without our excellent plan. So, you know, that was definitely very helpful this year, you know, there were a couple plans where, you know, we didn't have to increase the deductible at all. Because we kind of had this one time one time benefit of their changing logic, but just want to spend a little more time on that to kind of show the average changes year over year just, you know, that's the federal value increasing that kind of what we're what we have to counteract just to stay in compliance with with AV ranges. We also had another question on just what deductibles applied to in the different plans to just put together a quick table of kind of where the deductible is waved or applies. So platinum gold, silver deductible, pretty standard way for preventive office visits that's primary care and specialist urgent care and your ambulance. And then drag its way for generic scripts. And then on, you know, the rest of the plans, mostly it's just way for preventive. And then wellness and goes between just wellness scripts or generic scripts, wellness and generic for some of the other ones. So I think this plan design is probably the one that caused the most confusion or the bronze deductible plan with the pharmacy limit. So we have the medical deductibles only way for preventive. But then we have all these categories with that have copays. So in this case, you know, the members responsible up to 6450 and then between 64 and 9450, you know, they, they get some of the benefit. They just have the copays instead of having, you know, the co insurance rates. And then once they had 9450, obviously they're cost sharing. So, you know, this is definitely a somewhat confusing plan design because we have all these copays, but then, you know, on the medical side, it's only way for preventive. And then on the pharmacy side, it is way for generic drugs. So just wanted to run through that kind of plan design quick because that one's that one's a little confusing. Okay, so hopefully hopefully that helped kind of clear things up a little bit around the A.B. calculators. I know that can get very technical with kind of the updates they do every year, but I thought it was worth taking the time to explain that a little more and kind of show that the average changes. Any questions on that? One point to add to it's not it's not that the deductible is waived. Precisely, but as of last year, remember we made the design change to have the first three. Office visits or behavioral behavioral health or medical office visits at no cost share. So that's in addition to the treatment of deductible, but for those first three, we made that valuable addition. Just want to remind everybody of that. Is there anything else, Mr. Hulan or are you? Well, I can move to the overview of enrollment unless there are questions on this information from weekly. Okay, to move on. Yes, please. Thank you. Okay. People see my screen. Not yet. Darren, do you need to stop sharing or am I doing something wrong? I believe I did. Okay. So this is just an overview of the on exchange enrollment. And this is covered lives not by household. So this first slide just shows it by plan type. And so comparing 2022 covered lives in January to 2023 total enrollment is down about 1000. That's over. Comparing this number and this number here. So this is fairly consistent with what Addie mentioned last week that largely we think due to people staying on Medicaid that this is down and that, you know, sometime later in 2023, some unknown number is likely to transfer from Medicaid coverage to qualified health plan. So we'll be watching this closely to see how that changes. Specifically, we were asked about the enrollment in the plans that are impacted by the CSR. That's the 73 and 77% CSR levels. We've got a just over 1000 in the 73%. CSR level four and about 2000 in the 77%. So those two cohorts would be impacted by the removal of V CSR if that goes forward. So shifting to this color chart, this focuses on the changes in bimetal level and plan type year over year. So it's really down in most categories except for bronze, which is slightly up and the no CSR silver plan or silver plan type is up a bit. But again, down a little over a thousand overall. So I hope that's helpful. I really just wanted to provide that in the next month or so we will have the coverage map will come out, which is a broader look at all of the enrollment across different across different categories and including the small group and issue or direct enrollment. So we will certainly share that with the board. So that's what we prepared to show today. So turn it back to you. I guess if there are questions or other things that we can we can provide or answer today. Great. Thank you. And I'll open it up to the board for any questions or comments from the board. Just go ahead and speak up if you have any questions or comments. My only comment is I see that you and member Walsh must go to the have the same shopping experiences. I'll turn it to the health care advocate for any questions or comments they may have. Hi, Chair Foster. This is Charles Becker staff attorney with the office of the health care advocate. Just three quick points about the 2024 plan designs. First, I wanted to just say kudos to Dana will hand for running very efficient meetings and to the weekly team for their clear presentations and made making some difficult decisions a little bit easier to do. Regarding the plan adjustments, I just wanted to say that although those these are really minor adjustments, you know, we're talking about a few hundred dollars in the deductible here, a couple hundred dollars in the move there, some co pay adjustments here and there. That's really kind of cold comfort to Vermonters who, you know, even after paying their premiums are reluctant or even afraid to use their plans because they can't afford the cost sharing. So, you know, even though the 80 calculator limits the kinds of choices that we can make, it's still important to recognize that beyond premiums, cost sharing raises significant concerns are regarding affordability and access for for many Vermonters. But that was just an important point to make. And then third, regarding the premiums themselves, I think Wakeley's modeling showed that these plan adjustments would result in premium increases of around 1% give or take a few tenths of a percentage point. So it will be interesting to see when the rates are filed in May, whether the rate increases are closer to historical norms or whether we again see double digit increases like we saw last year. And I'm sure we can hopefully all assume that it will hope that it will be the former. And that's really all I wanted to say on behalf of the HCA. And so thank you for giving us the opportunity to comment today, Chair Foster. Thank you. Mr. Becker on the affordability piece. Does your website have some resources about the impacts of affordability and people's ability to pay the cost sharing components of these? I think I've been on there and seen some materials. You know, I'm not sure quite off the bat. If we do have any of those resources, let me take a look for you and get back to you if I can. Okay. Yeah. No, great. Of course. Thank you very much. I appreciate it. And with that, I'll open it up to public comment. Please use the raise your hand function. I'll call on folks in the order in which their hands are raised. Mr. Carpenter, how are you, Walter? Hey, all in. Hey. I'm hanging in there. My second GMCB meeting of the week, so I won't go through withdrawal symptoms. You do as many as I do. Maybe more, right? Historically, definitely. Yeah. Historically, you're right. Probably about a thousand. Anyway, I just wanted to back up the legal aids comment and say that the only thing exceptional about American healthcare is how it screws the patient with these deductibles. Typical Walter comment. We appreciate all of the comments we receive and I appreciate you stepping up and making your comments, Walter. So thank you for doing it. Are there any other public comments? Hearing none, I'll move. And I move to approve the 2024 qualified health plan designs as presented by the Department of Vermont Health Access. I'll second. And all those in favor, please say aye. Aye. Sorry, Dr. Murman, I didn't hear you. Yes. Sorry. Issues. No, no, that's fine. And I'm also an eye. So the vote is unanimous. And it carries. Well, we thank you. And as I'm understanding, there will be no modifications we would go with the proposed designs in each case. That's correct. Thank you. Thank you for your presentations and making this very easy for us to understand a complex area, especially for myself as a new member. So thank you. Thank you all. Great. And with that, we'll turn to any new business. Old business. And is there a motion to adjourn? So moved. Second. All those in favor? Aye. Aye. And the motion carries. Everyone have a nice day. Thank you very much. Thank you.