 There are sign-up sheets, so if you wish to speak, please make sure you sign up in the right-out-of-the-hall way, right? Yes. Okay. And the purpose of tonight's public hearing is to give the Green Mountain Care Board an opportunity to hear from the public about their comments about the QHP filings, which are the exchange health insurance plans. And we're going to get started right away because we want to make sure that everybody who wants to speak gets a chance to speak. Hopefully some more people are signing up. The first person to sign up was Mark Stanislaus. Mark, if you could step forward. And my understanding is we have been asked for you to say your name and then spell your last name so it can be accurately recorded. And I'll also add we're trying to make sure everyone gets heard tonight so if you can keep your comments to around three minutes or under, we'd appreciate it. Thank you. I'm Mark Stanislaus, Stanislaus, S-T-A-N-I-S-L-A-S from St. Alden's, Vermont, and I work for the University of Vermont Health Center. And again, Mark, if you could use your theater voice because the people behind you don't want to just not hear anything. Mark, can you step up to the mic a little bit closer? I'm trying to find two things here. Hello, Mark Stanislaus. Hello. I've got something there. It's coming back here. It is. Okay. Good. Okay. Anyways. I want to talk right into it. Yeah. There's a presentation here. I would just stick to the talking points to see if there's more questions. Okay. But, you know, at a very, very high level, you know, this is about connecting the dots. This is about connecting the dots between two separate processes. And if we go to slide two, okay, the backdrop of this is, you know, this is more of a conversation of how do we engage in a starting point here. So that's all this is, you know, the data elements may not be perfect. All of the data elements are from Green Mountain Care Boards in, you know, processes or posted on their website or other information, you know, gathered from Green Mountain Care Boards staff or hearings. Okay. So basically, you know, we know where to start. I picked four areas to start the conversation or to put out there to start to engage in the conversation and made some general observations on each one of those four areas of focus. Moving on to slide four. Basically, here's the issue I am. You know, that's the same grid that you saw on the first slide. What is driving the difference between hospital approval rates and commercial and chair approval rates? You know, these rates have been more in line through 2016 and they become, they started to become a little bit distinctively different in 2017 moving forward. And that's just how do we connect those dots? And there's footnotes at the bottom as it relates to those data elements. All 2019 rates are based upon submitted rates and, you know, none of those have been approved based upon my understanding. So this whole presentation is about how do we connect those dots between those two processes and, you know, and, you know, where to start. So I'm going to start by saying I've been doing this for more than 20 years. Okay. And it's difficult for me to connect those dots. So I can just imagine how it is for the consumer to connect those dots, you know, you know, between the two processes when to the commoner it seems like they should be easy to connect. But they're simply not today. Okay. So basically I took all of my 20 years of experience and I sat down and I just thought about this. Going to slide six. Okay. We know there's some various talking points there but I will go right to the bottom. It's complicated. It really is complicated. Okay. And basically what helped me to start, start to connect the dots and you're going to hear me use the word start initial observations because more people need to be engaged in this conversation to help improve that connectivity. But basically it took me like three years of great files which is on a later page to start to see how we can start to connect those dots. Okay. So item number one of the four items that's on slide seven. Very simplistically the payer plans process starts in January. The hospital process starts in October. Okay. Those are two different kind of starting periods. If we go to initial observations on slide eight. Jumping right to the bottom. Okay. It's going to be very difficult to change either one of those starting periods. It is highly unlikely. So the best that I think that we can do is start to understand what the impact of the differences of those are and start to work better to make that interpretation from one to the other. Okay. Observation number two is the base starting period. Commercial insurance process starts with actual and then they make adjustments from their projections from there. Okay. Well the budget review process is budget budget. There's definitely an opportunity to better align those. Okay. And it would require a lot of conversations and a lot of people pulling in the same direction. But I think there's a possibility. Mark, can I ask you to speed up? We have a lot of people. Yeah. Okay. I'm going as fast as I can. Okay. Okay. Okay. Finish up. Okay. And anything that you don't get to you obviously can submit it right. Yep. I'm trying to go through these slides too. So and this will be submitted also. So, you know, on the core definitions, the commercial process is PMPM change. The hospital review process focuses on total patient revenue change from period to period. Initial observations that comparing these two definitions are apples and oranges. You know, those two processes do not talk to each other very well. So basically, is there opportunity to start to initiate the PMPM process into the budget review process? It's going to take time to do that. Yes. Number four, okay. There are a number of items that are outside the green non-care board hospital review process that are included in the commercial rate balance. And it's going to be very critical to understand that. If we go to slide 13 and just speak to some of these initial observations, based upon the Blue Cross Blue Shield presentation, they said that 53% of the medical pain experience only falls under green non-care board broad review. There is a little grid down below on slide 13 on how that could be better aligned. I think this process could start for FY19. Okay. There are other areas that we could do in FY19. I can speak to the board a little bit later exactly what they are. But I think we could start to take a look at a very high level at that actual starting place and understand the change from FY2017 actual to 2019 budget and how that compares to some of the previous rate violence. Mark, I'm going to ask you if you could close up right now because we have a number of people here so people can see that. Okay. I have two more slides. So if you go to slide 14 there, this is just the attempt of aligning all three of those years together that helped me at least start connecting these dots. And this is going to be critical, connecting those two pieces. And then if you go to the last slide, you know, slide 16, this is exactly where we started. This connectivity isn't there today. And if it is there, it's not very clear and certainly not clearly of somebody that has a vast amount of experience. So thank you for your time. Thank you. Thank you, Mark. Next is Nancy Detra. And right after that, if we can get Megan Gardner to be ready. Nancy here. Yep. And again, for those who came in late and can come up, please say your name and then spell your last name so it can get accurately reported. Hi, I'm Nancy Detra, D-E-T-R-A. And I'm from Gilford, Vermont. I live with depression and with good care on my part and the part of my doctor, I've been mostly healthy. Last summer I felt into a deep depression. I was taking two antidepressants which together had kept me stable for a long time. But I found that those medicines no longer held the depression at bay even when my psychiatrist adjusted the dosages. She then suggested I try transcranial magnetic stimulation or TMS to control the illness. She believed it was my best shot at regaining my health. I had Blue Cross Flu Shield as my insurance provider through Vermont Health Connects until I was told that it would not pay for TMS. Then I switched to MVP which would pay for it but only after I had proved that I had reached rock bottom in my depression. I had to get worse before they would pay to help me get better. What should have been a decision between me and my doctor was dictated by the insurance company. When I finally got to have the treatment, I did get better and maintenance treatments which MVP approved have kept me healthy. But when I turned 65 in June I went on Medicare Parts A and B, Medicare Part D through Humana and a supplemental insurance through again Blue Cross Blue Shield. In total I'm paying $338 per month for health insurance because Medicare will not pay for maintenance TMS. I'm paying an additional $600 per month for treatments every other week. If Blue Cross Blue Shield breaks go up I won't be able to afford both the insurance and the TMS maintenance treatments. I can almost guarantee I'll reach a personal health crisis is just a question of when. This is not health care. It's a lottery and a very expensive one. I urge the Green Mountain Care Board to deny rate increases and move to a universal care system as outlined in Act 48. Thank you. Thank you, Gloria. I'm here at the Vermont Worker Center and I pay roughly $80 a month in switch. I recognize this is pretty low and therefore covers the bare minimum. I treat it as preventative care and rarely go to the doctor for the things that I would go to, the doctor for mental health assistance because in the past it's always been you have to pay your deductible although my deductible because my monthly payment is so low is very high. I'm a baker by choice. I have a college degree and I like paycheck to paycheck and that is 100% my decision. When I was 22 and I made that choice, I didn't think about health insurance rates and finances and any of that. I thought about what I wanted to contribute to the world and what made me happy and as I've gotten older the having to balance what makes me happy with what is able to be provided for me and what I can provide for myself has been a hard concept to realize. Just to give a brief example, I broke my foot or I thought I broke my foot two months ago and had to go get an X-ray and with my insurance that cost $250 which to some people may not seem like a lot of money but for me that's a couple of days of work and sidelines a lot of things for me. I just asked that the board acknowledges what a rate increase would do to a lot of people in the state of California and 8% I think on that spreadsheet it said potentially 10.9% within the campaign. Is it drastic change? It would affect a lot of people including myself. And I just ask that you consider what that will do. Please no more rate hikes. Health care is a human right. And we're seeing Smith. John King and KING. I would just like to acknowledge that I'm on Medicare. And so far I haven't I've been okay with that. But I have a family member who is very unemployed low income. And it's a constant struggle. This is a constant struggle to find money for this person's health care. And all around me I see people low income people people on the margins who are struggling to have basic the basic right of health care. It doesn't feel right. It's already very difficult for people to afford health care. And now there's another yet another raise. It doesn't make sense. It doesn't feel humane. It doesn't feel right that people have to suffer so much and become so strapped in order to pay for their basic income. It doesn't feel right. And now there's a raise for one month. So I protest that. I think it's terrible. So that's what I have to say. Christine Smith on Epidet is April 4th. My name is Christine Smith. I live in Mary. I've been here five years. And I was at when you guys had the three mountain care board down at the city center last year. I don't know if anybody remembers me from that. I've changed a little bit. But the ones that stopped outside and spoke to our group I want to applaud you. You have heart to know what we're going through. I didn't write anything down. So I'm just taking this from my brain and what I can remember. Last year Blue Cross Blue Show got somewhat what they wanted. More money. More heights. What is the elderly people supposed to do who can't afford it? Do you guys keep raising it? Basically we're all going to hell because we can't afford it. I'm on disability. I take care of my mom since I've been 18. And I think a couple of you remember that I said this last year. I was in high school when I was taking care of my mom. I just had surgery this year all by stomach. And if it wasn't for the insurance I have I would probably die. Or I would be having more problems than what I am having now. But Act 48 needs to be pushed and I hope and pray that all of you guys have heart and do not give Blue Cross Blue Show what they want. Because the more we give the more we're at. Period. Think of the people who don't have nothing at all. And if you guys have heart and dignity you guys won't give them anything. Thank you. I live in Plainfield and I'm a member of the Vermont Worker's Center. I've spent most of my adult life either uninsured or underinsured. I've experienced firsthand the way our current health care system prioritizes profits over human rights. Six years ago I had an operation to repair an inguinal hernia. I had noticed hernia several years ago so I had to ignore it until I had insurance. In February of 2012 it became too painful to ignore and I luckily was insured by my employer at the time. After the surgery I was left with several weeks of recovery and $4,000 worth of deductibles co-pays and various out of pocket expenses. I was with insurance, $4,000. Fast forward to spring of last year I was doing my taxes. I was at Vermont Health Connect for several years at that point. I was on Blue Cross Bushield's bronze plan the only one I could afford. Ironically I tended to avoid getting care whenever I could because I had a $6,000 deductible. I found out that tax time that actually had made too much that past year in relation to the subsidies that I was receiving from my plan and I owed over $1,300. I couldn't afford to pay that. I would have signed up for a better plan before that so I ended up paying for the next 13 months a tax payment plan. Slowly paying that back. Fast forward to this year. In April of this year I woke up one morning with my right eye red and swollen. It looked like someone had basically punched me in the night which obviously had new concerns so I went to urgent care. They suspected it was an infection, gave me some antibiotics and a topical cream. At this point I was now on Medicaid and I had to pay a dollar for the antibiotics. The antibiotics didn't really do a whole lot so they prescribed some stronger antibiotics. Those didn't work either so they finally recommended me to a specialist who ended up diagnosing it as a chelazion. The clogging of the oil lands around your eyelashes and they did an incision to drain the swelling. I don't know if you can see from there it's not actually perfectly fixed a little bit. Right now I'm just under the limit for Medicaid which is $13.97 per month for a single adult here in Vermont. That's not a lot of money. Out of that I need to figure out how to pay for rent, groceries, car insurance, car repairs, my student loans, utilities and as most of you know generally cost of living is going up in Vermont not the other way around. On the other hand I'm pretty terrified of the idea of suddenly making too much money and going back on Vermont Health Connect. If I had been dealing with this, my eye while I was on my old bronze plan I probably would be thousands of dollars in debt and those healthcare costs would be pushing me back towards the end and pushing me back towards poverty and this is a real worry for me and thousands of other people in this state So basically in conclusion I'm tired of having to jump out of the fire and I think we need to have no more rate increases we need to treat healthcare like a human right we need universal healthcare through implementation of Act 48. Thank you. My name is Tanth Kelman I'm a member of the Mark Workers Center I live in Washington I also teach at Randolph Union High School As a teacher I see the healthcare crisis that we have in this state in my classroom I teach in a community where the proportion of families in poverty has climbed from 20 to over 50% in the little less than a decade that I've been there and a tremendous amount of that is related to the increasing cost of healthcare this board has approved rate increases over the past four years on an average of almost 40% my wages have not gone up anywhere close to 40% very few of the people who are sitting in this room have seen anything like that so we're seeing this incredible spike in one affordability of something that as you're hearing should be a basic human right and as a matter of fact in our state's law in Act 48 is defined as a basic right I believe that that same law passed all of you with moving us toward a system that treats healthcare as a public good and a right rather than as a commodity when we instead continue to prop up this system that allows corporations financial solvency to be placed above the ability of working families to access the care they need it takes a toll on kids I myself am lucky enough to have a plan through my job that I'd like to pay less but I can afford it and whatever rate increases it's not going to put us out but my wife and I recently had a baby and that's an expensive proposition and had we been in a slightly different situation we would be in thousands and thousands of dollars worth of medical care and I know this because the families that I serve are struggling with that situation and when families can't access the care they need or when they struggle for their premiums or fall into the Medicaid gap their kids suffer and their learning suffers indirectly through unmet physical and mental health needs or indirectly through the stress that it causes to the parents trying to make ends meet and pay for these rising premiums that they keep seeing so I'd also like to say that you know with regard to this particular hearing I teach English and you all have provided really an object lesson in ironing by denying the public advocate the chance to speak at this hearing I think this is the second time I've been but I know that the workers center has been sending folks to these hearings for a long time we've been saying the same thing we can't afford these rated increases we can't afford any rated increases we want a publicly funded universal system that allows everybody to get the care they need and we wanted it in 2011 when we passed this law we can't afford any more rate heights thank you I think I have that right my name is Kurt Erikson last name E-R-I-C-K-S-E-N I'm a resident of Montpelier Vermont veteran of the United States Coast Guard and currently general manager of Vermont Compost Company at Vermont Compost Company we have 18 full-time employees most of them around my age annual salary level we're mostly supporting local small-scale organic agriculture throughout the Northeast and the Midwest so we have a lot of people that are fine making a little bit less money it's passion-driven work as a company we don't have the margin to where I can afford to pay a proper health care plan so we take the fine by the state each year and what I say to my staff is anyone that wants to go out on market get health care through Vermont Health Connect will reimburse 50% of what that cost is what I can say is that with 18 full-time staff they look at the return on that investment just as a poor investment so when they see the cost of what their health insurance is compared to the cost that they're going to be stuck with anyway coming in and out of a hospital basically between 25 and 42 it's just a poor investment I personally am paying $386 a month for a plan especially coming from the Coast Guard I understand the value and sort of the pressure that you don't have in your life by knowing that you have those costs covered but when I look at rate increases and I think about the fact that I've been spending $400 $450 a month in comparison to what my needs are on any given basis the fact that I have a whole staff that's like health insurance is a bad return on investment I'm just not seeing it it's taking 7 years, 10 years, 12 years before there's a bad enough incident or there's something terrible enough in my life to where it's worth it for me to get money out each month so when I look at rate increases it's not should they do it or should they not should it be universal health care just from a practical standpoint the return on investment at the current price isn't there there's just not enough benefit so to think that that can be increased when you couple that with some of the ridiculous charges coming out of hospitals it's like pretty much everybody my entire staff is disgusted with the whole health care system right now and whether it's act 148 act 48 or another method I don't know what the answer is but I just know that they're disgusted and if Vermont is concerned about keeping people in that age bracket with decent insurance they've got to do something about it and allowing rate increases that's not going to help I will guarantee you that the number of insurance individuals between 25 and 45 is going to drop and that's a problem I'm sure everyone's aware of the risks that I have and people getting under debt and all of that sorry, poor public speakers anyway and the other thing is as a small business when I hear about act 48 as a small business the most beneficial thing out there is decent health care coverage at a reasonable cost so if I had the ability to provide better health care for employees I'd be a whole lot better at recruiting talent and it's a huge obstacle and right now the state is failed thank you good afternoon I'm Manny Mansback that's M-A-N-S-V-A-C-H and I'm in Athens, Vermont can you hear me in 2012 at age 52 with a very good health history and many more good health habits than bad ones I found myself in and out of the hospital three times in five weeks through no fault of my own I'd contracted a common virus that led to a dangerous if untreated inflammation of the sac that surrounds the heart known as pericarditis I was able to receive very helpful life-saving emergency and follow-up care and I came out more or less okay in this situation and was told I'd have no greater chance of developing heart disease than the average person I was fortunate to have lived at that time in Massachusetts and had I not been enrolled in mass health at that time in addition to my medical problems I would have been in a world of hurt financially as the ordeal involved with the procedures in addition to the cost of several days in the hospital so now I'm concerned that as Congress and the administration in Washington seek to destroy Medicaid and other aspects of our social contract that if I become ineligible for Medicaid because I make a few dollars too much that Vermont health care plans will be exorbitant and like people have been talking about eat up hefty chunks of my resources and the resources of other Vermonters I'm confident that this board that Vermonters aren't getting wealthier in proportion to the increases that Blue Cross and MVP request annually including this year and as someone else mentioned that it's a great injustice that these companies didn't think that they could count on their own arguments and data to get the hikes they wanted but felt it was also necessary to employ fancy legal maneuvers to file to silence Mr. Fisher and important in this context a legacy for the people affected by these rates I think this is shameful and sleazy and shows the desperation that those who are managing our health care system will go to get their way if you don't like the message silence the messenger or call it fake news and bold caps on Twitter as a health care professional a mental health care professional for almost 30 years I'm very aware of the stressors that contribute to people's disease it breaks my heart to witness that in this the wealthiest country in the history of the planet anxiety about difficulty accessing health care is rapidly growing as a stressor in and of itself that undermines good health it's a vicious cycle as a large segment of the very rich gets so richer and commit themselves to undermining the social safety net that I believe should be a given for all not only are people finding it difficult to access effective health care but the worry about this is itself becoming a factor that makes well-being more elusive while I imagine that some members of this board sincerely believe that you're serving the public good as best you can I suspect and frankly hope that somewhere in some part of your mind you know that when you more or less rubber stamp most of what the insurance insurance companies asked for you're participating in an exercise that amounts to a little more than rearranging the deck chairs of Titanic that each year in these hearings you're deciding not whether or how health care should be available to folks but to what degree you're going to continue the trend under these republican administrations of saying to decent hardworking people you're sick too bad good luck as you continue to make it harder for people to afford health care if you continue in this vein without doing the hard work of working to enact act 48 which is the law of the state then I think you're really not serving the public good ordinary Vermonters insist that you help fulfill the promise of act 48 and work to develop a system that treats health care as a fundamental right for every Vermonter no matter who they are or how privileged they are please do your real job I'm Mary Alice Bisbee and as some of you know I sat for the first part of the Blue Cross food shield here in the other yesterday and couldn't stand anymore when you left for 15 minutes for lunch I decided that was all I could take my name is Mary Alice common spelling Bisbee I'm a native Vermonter seventh generation Vermonter and the only person I remember seeing that I know is Robin and now care board the whole board has changed politically I think in this atmosphere so I have been an advocate for universal care single payer health care for so long since the 1960s I believe I'm 81 years old I've seen a lot of changes I've gone through a lot of changes and when I was 34 years old my grandmother with two children my ex-husband an MIT graduate decided to move back to Vermont after we'd been all over the country and I had a nervous breakdown after smoking one joint of marijuana and a week later I had a psychotic break it threw my life into turmoil as most of you know I now live in subsidized housing I'm very grateful for three squares they give me $15 a month and I get a few other services but I will not take Blue Cross Blue Shield or MVP I have united health care and I've been grandfathered in and I know people will say that's ridiculous they're terrible but they have grandfathered me in so that if I go in the hospital and need to be in rehab and get any kind of home health or rehab services no deductible, no co-pay and this is all due to what different people have changed in the legislation that you have brought about here we need universal primary care first and I fought for that at the state house nobody listened nobody listened we need universal care around the country and to think that we're the richest country in the world and we do not have this as ridiculous and I feel terrible I know most of you earn over $80,000 a year just to sit on this board what are they doing what are you doing to help us I don't see anything being done I see us going up 6.9% I listened to that hearing the other day his name was Jay Leinkoff talking about what is affordability nobody can even define it we don't know what affordability is I've got my notes here $63 million is supposed to be coming back to Blue Cross and Blue Shield and they didn't even put that into there the person who spoke Mr. Schultz I think his name was said that they couldn't even put that in because they hadn't received it yet and that Vermont has these horrible rules about that ages can younger people have to pay the same as older people and all these wonderful rules that we put in are now coming back to haunt us because the insurance companies and the insurance companies blame the hospitals for the high rates the hospitals blame the insurance companies and what about the consumers I'll let it go with that I'm also a member of I don't pay my dues because I don't have much money but I'm with rights and democracy too and I'm with healthcare for all and a lot of other groups that are working to find something in our state that will meet up to our goals and our our heart thank you my name is Grace last name in 2014 after working for the same company for almost 20 years I suffered a massive stroke and the result what resulted in that stroke was because I had a high deductible insurance plan and I wasn't able to afford to go to the doctor and they didn't diagnose that I was pre-diabetic and I had this massive infection that caused my blood sugar to skyrocket that caused the stroke and as a result of that stroke I no longer am able to work and be a contributing member of society so I put my efforts into helping other people to be in the same position and trying to let people know that if you're not paying attention to what's going on around you everything that you think is yours is not really yours you're going to lose it I lost my house, I lost my job the only thing I didn't lose was my desire to fight for better health care and reasonable accommodation for people I'll keep fighting for that for the rest of my life and I'm terrified that if I get sick again for some reason every spent cent of my resources are gone I have nothing left I get a small amount of disability every month which is not enough to keep me able to have an apartment or anything so I'm fortunate enough to be able to live with friends and the kindness of my friends is what pulled me through all of this and the people who are here from Vermont Workers Center have been a huge part of that and the other people in the community who understand what happens to people when they have a catastrophe like this and I have no redress to the insurance company they won't say to me we're sorry Grace that you lost everything that you worked for for your whole life because you couldn't afford to go to the doctor so nobody's going to say they're sorry to me and I don't expect them to but what they can't expect from me is that fighting against me increases and high deductibles for human beings so they can survive in the world thank you very much for your time and shorts I'm Spoon Agave A-G-A-V-E I'm going to approach this from two angles one is as a school board member in Burrattle borough I deal with all the other members and everybody else there at virtually every meeting with issues related to poverty because we see them as issues with the kids we have a I think about the lowest average household income in the state in the Rattle borough so we have a very high rate of poverty so anything that happens that puts even more stress on these families reverberates to more problems with the kids more expenses in the schools we've gone to a point now where every school has to have a social worker soon we're going to be hiring social workers that know a little bit about teaching and it's just real serious and it's so obvious that so much many of these special needs are coming out of poverty and health care the cost of health care is a huge contributor to that poverty and then the second way that I want to approach my concerns about health care is as a retired person my income is $1274 a month from social security which is just about the average across the country for people receiving that and fortunately I still have enough health to pick up a little under the table work and I have a little bit of savings so I'm managing okay nevertheless between my supplementary or gap insurance I get some help I get some Medicaid through that I think helped me meet the farm program and something that helps me pay some of my part B but I have the gap insurance I have part of the part B and I have some co-pays and I have co-pays on my drugs for my emphysema I put out about $200 a month on average or a little less out of my income of $1274 a month and that in the near future within I hope not not as soon as but if I lose that extra income and my savings are gone I'm in trouble so for me I'm like probably a very large slice of the population that sits in retirement and right on the edge thank you Mavis Ellen Schwartz S-C-H-W-A-R-T-Z I'm from Browleboro and I'm a member of the Law Worker Center I'm on Medicare which means that I am not directly impacted by these proposed increases though I do remember a time in my younger years when I was uninsured and I remember how scary that was in this country if you're old, like me you're deemed worthy of access to health care well at least an 80% of the cost I'm speaking today because I cannot sit in silence just because I have the good fortune to benefit from a public health care program while others are priced out of the health care marketplace that is our current reality and these increases if granted will only intensify and extend the damage the real problem is that we have a health care marketplace at all health care shouldn't be treated as a consumer good accessible to some but not to others it's a need that we all have by virtue of being human I'm guessing that those of you on the board, like me can access care when you need it as you consider the rate hike requests I implore you to think about the people in your lives people that you know and that you love and ask yourself which of those people deserves not to have health care to which of those people would you say sorry the premiums too high or too bad you can only afford a high deductible plan I hope that you would never relegate that someone you care about to that fate and that as a public board you would take seriously your obligation to all Vermont residents I also have serious concerns about how independent the board is of the insurance companies the Green Mountain Care Board Interact 48 is an independent board I've been attending these meetings these hearings since they began and this year for the first time the office of the health care advocate has been locked from laying in so how independent is the board of the insurance companies it looks to me like they get to call the shots about who counts and who doesn't the only voice that people in Vermont have is the testimonies that you receive from people like us here tonight which if I remember from last last year's hearing we were told they don't actually count since none of us have parted status until this year we were also represented by the office of the health care advocate and now that voice has also been removed so from where I sit it looks like the board is not independent of the insurance companies you're supposed to be a regulatory body but how can you fulfill that function if the only testimony that counts comes from the very companies that you're regulating according to Act 48 which established the Green Mountain Care Board the board's first aim is to improve the health of the population that same law states that systemic barriers such as cost must not prevent people from accessing necessary health care that's actually important from the law your board has both a moral and a legal imperative to ensure that premiums do not stand between people and needed care ultimately the solution as spelled out in Act 48 is a universal publicly funded health care system I urge you to reject the rate increases and to do all within your power to move us to the full implementation of Act 48 with the promise of free mountain care not as Medicaid but as a public system for every Vermont resident so people never again have to come before this board pleading for the basic human right to health care thank you Hi my name is Kevin Wagner W-A-G-N-E-R I'm from Bradford and I get health insurance through Vermont Health Connect up through MVP and I'm starting to reach an age when I'm not as healthy as I used to be and health care is becoming an increasing concern for me and for my wife and because of the high deductibles we pay for our plan every time we need care it's a matter of we're going to be paying for months in the future it's definitely a barrier for us and it does cause us to like restrict the care that we seek and it's and we're fortunate that we don't have anything truly serious of looking us at the moment but it's seriously anxiety inducing knowing that if something serious does occur what are we going to do how are we going to continue to dignify lives and I hear a lot of discussion from and around the board over what's the financial viability of the insurance companies but Blue Cross Blue Shield and MVP they don't have a right to live people have a right to live health care should be treated that's human right a public good for all sir I'm very familiar with I first became familiar in 2004 when I was a school teacher in Barry and Blue Cross Blue Shield we went on strike the next year it's 2018 and I believe that this issue of rate heights and teachers and paying public workers is still a big issue but still happening in 2005 health care is a human right campaign first began it's 13 years later and we're still here the Blue Cross Blue Shield CEO is still making more and more money and we are making less and less money and more people are without insurance under-insured or dealing with huge gaps I'm now a small business owner and I recognize that the differences that these heights make not only affect me personally and my colleagues but also the taxpayers and also the folks that I could potentially be hiring but I can't afford to can I increase my services to clean homes and to keep up with these costs I'm going to lose beds I'm going to lose business assistance I feel fortunate that I can pay I think that I want to be able to pay into assistance and that's what universal health care is all about if I make less money then I might go down in my tax bracket or go down in the levels and I'll be possibly eligible for Medicaid I believe that all we're all in and it's an equitable fair, transparent health care system that we need Act 48 is a start but we really need an expanded Medicaid plan for all health care for all no more rate increases and health care is the basic Before you go to Walter, I see the health care advocate is by the door and I don't want to leave without giving him an opportunity Can I have 30 seconds? That would be great because there seems to be a big misconception here and you could explain that your office has been involved from the beginning Good afternoon I just want to take two seconds to say that I'm Mike Fisher on the health care advocate and to let people know that I was able to speak today at the MVP hearing I just thought people should know that when they're getting up to speak and you guys are doing great It's more than just getting an opportunity to speak, what his office has done is they have party status through hearings and they have been involved in asking questions from the first date that the filing was made and Mike deserves that round of applause for just giving them more of an artwork that he's been doing C-A-R-P-E-N T-E-R I am a health activist with Dr. Deb Richter Dr. Deb Richter and Vermont Health Care for All and I thank the care board for hosting this public hearing and something that I know was rare for me in that the board members cursed know me might be shocked by I do not have much to add to the testimony you had earlier to your shock or my shock or my actually Many years ago, long before the Green Mountain Care Board was a gleam in our eyes I had Blue Cross Blue Shield instruments through an employer In 23 2003 I had my gallbladder taken out of me after a massive gallbladder attack The copay was $50 A year later it was the turn of a colonoscopy The copay suddenly jumped to $250 When I inquired of my insurer that our cost went up My wages did not go up to meet your costs I replied Yes No problem Several years later one of their CEOs retired with a $7 plus million golden power issue That however is not what I want to say here According to an article in Seven Days Blue Cross Blue Shield collects millions from Vermont just each month It's also a non-profit Also according to Seven Days Blue Cross Blue Shield does not pay state taxes This means that we the people pay state taxes that they do not pay Since we subsidize Blue Cross Blue Shield with our premiums and so on we are also subsidizing them with the state taxes that we do pay on their behalf In essence we are being double taxed to support Blue Cross Blue Shield No matter how you cut it it is a form of tax The thought I want to leave here was spoken by Dr. Deb Richter of Vermont Health Care for All in that Seven Days article on Blue Cross Dr. Richter posed a rhetorical question about the purpose of Blue Cross versus us Do they exist for our benefit or do we exist for theirs This is the ultimate question we need to ask ourselves Thanks again Someway followed by Alec Fleischer I'm wondering my own testimony as well as a friend of a friend who is a teacher in Springfield I'm going to start with Amanda Frank Hello My name is Amanda Frank I live in Belmont, Vermont having my master's degree is 10 years of teaching experience I take home $1811 every two weeks My husband is a stay-at-home dad so we are in a one-income family I deductibles My family is already in a carous financial situation A rate hike would not only cost further financial strain but also for the health of my family despite having both an FSA and HRA I was paid up for prescriptions and waited several weeks for the claim to be processed by Blue Cross Blue Shield and the Third Party Administrator currently I'm waiting to be reimbursed for prescriptions from June and July $1,263 35% of my monthly take-home What are our family members? Is the chronic condition So far we've been able to continue filling all prescriptions with an increase in premium costs to make the unthinkable choice of which prescriptions to fill and which should fill without I chose some of my colleagues this is why we are saying today health care is a human right no more rate hikes Now for my own testimony Hello My real name is S-H-U-M-W-A-Y I live in Wilder and I'm a member of the Royal Worker Center This is the third year I've been to this testimony to speak to you all This is the third year that my wages haven't raised at the same rate that Blue Cross Blue Shield and MVP are asking their wages to be raised for their rates to be raised I hate to say this but I plan to be here next year because CEOs' pays will rise and my wages won't be able to see a doctor This is true not just for me but for people all across the state In 2011 the Green Mountain Care Board was tasked with figuring out universal health care and this rate increase, guess what not universal health care This is in fact a giveaway to the CEOs of Blue Cross Blue Shield MVP We know that because there's spokespeople who spoke to you yesterday and today actually advocated and I believe it's called to have the public advocate not speak but we know that the CEO is interested only in raising rates and not in our livelihoods because the people that are representing us were asking not to speak I'm here to tell you that I'm going to be back I'll be back next year the year after that and I'm going to be here until you all figure out what your job is which in Act 48 is to implement universal health care That's why I'm saying no more rates no more rate hikes healthcare is human right universal health care now Thank you very much My name is Alec Fletcher F-L-E-I-S-C-H-E-R I'm a student at Middlebury College and I have an internship here in Montpelier this summer I have the honor of hearing I just want to start off with you guys know a lot more than we do you're very technical and you know the details but we do know the morals you've heard the stories today and you really please try to take that into account Blue Cross Blue Shields is trying to raise rates as you know 7.5% this year and 36% since 2014 this is at the same time they're holding company Anthem corporation I just looked it up 5 years ago their stock price was $84.79 today their stock price is $246.08 that's a 290% increase has anyone here made any of that money all they've seen is their rates increase and to be precise 36% since 2014 probably more than that if you go back 5 years so the real question is should for Monters be able to pay for insurance or should for profit corporations make more and more money to benefit only their shareholders and I just want to say everything you do is political you're trying to be in a political body but if you take a stand and say no, no more rate hikes what will happen maybe we'll make the news maybe nothing will happen but you will have at least a spark in funding Act 48 so everyone here can have insurance and get the health care they need everything you do is political so please take a stand you are on an incredible pedestal and please use that power thank you and thank you for listening to us Keegan Harris and that is all the names I have if anyone has not signed up there's one more I believe please let Adretha who's helped by the door now hi my name is Eliza Hale I live in Washington, Vermont and I recently I had a baby this past spring in May and at the time that she was born are the fortune of being on my husband's health insurance to his work he's a school teacher and at the time that our daughter was born the complications with their health care provider were underway and there was a blackout period happening with the HRA handling a lot of our claims so we had the light of getting all the bills from the hospital before they knew the process and it really made me realize just how how much it cost to have a child and that's just the first the first piece that's just the first that has nothing to do with all the costs that come down the road it's probably the most expensive health care item that any family can have is a member and there's nothing like having a baby I think that makes you kind of think about the future and about the state of things and how the world will be when your baby comes to appointing their lives where they might want to have a child the increases are going the rate types are going I don't think my daughter will ever have a chance to have a child because of how much it costs so I just think that it's worth investigating how your body can do more to improve the lives of everyone especially those who live in the region Good afternoon My name is Keegan Harris I live in North Thetford, Vermont sorry last name is H-A-R-R-I-S I work as a spring field school teacher I heard one of my colleagues testimony was earlier pretty routinely struck in conversations that I have with my colleagues both teachers and support staff in the school and then most tragically with my students and their families about how they can't afford health care and I can't afford health care it is distressing to see the costs of insurance provide a barrier to accessing the sorts of services that human beings need in order to sustain their lives health care costs and in particular insurance costs both provide those barriers and also drive us either into or deeper into poverty and working in the community that they do I see the effects of that pretty firsthand our health care is a human right that is being denied us by the current system and as has been frequently and eloquently portrayed by persons giving testimony before me your board was created to see us transition to a universal health care system by July 1st of last year so I'm calling on you to refuse these rate pipes and do the job for which the board was created give us universal health care now, thank you what else on the list, if anyone wants to speak what do you call it? Hi, good afternoon I'm Sean Stevens S-T-E-H-E-N-S I live in Montpelier here I find it hard to hear from back there I don't know if anyone has access to an amplifier that could get turned up a little bit with the people at the back when I appreciate it I am a speech and language pathologist I work for a little non-profit organization between the premiums that I pay and my little non-profit organization pay to Blue Cross Blue Shield we pay about $14,000 a year so since I started there in 2013 we have paid Blue Cross Blue Shield $68,000 and in return for that I have received a physical that's all I've received one single physical and I say that to set the stage for an incident that happened a year and a half ago on my son's birthday when I bought him a bow an archery bow which has a fancy stringer and this bow, I'll keep this short it sounds long but it'll be short with a stringer with a modern bow you step on the stringer and pull up to put the bow string onto the tips of the bow but the stringer slipped off and the bow came up and hit me on the forehead above my eye and it cracked this bone and it punctured my eye and I fell on the floor bleeding from the eye socket and worried that I'd cracked my skull and my son asked me should I call 911 and as I was riding around in a pool of my own blood I had to tell him no don't call 911 we can't afford it I feel like I never want to have other parents be in that situation I won't have other children be in that situation and so I would ask that we try to figure out some way to get around the situation that we're in right now thank you we've gone through everyone that's signed up I just want to make sure that everyone has an opportunity at the heavens to come on down my name is Britta Fisher E.R. I'll keep it very brief I would ask the board to consider the factors that are driving up the race as you make this decision it's a pretty simple question what is more important growing the profits of the insurance companies year after year or providing health care and ensuring the health and safety under Governor Shumlin's own plan to finance Act 48 we saw that there was enough money to fund health care for all in Vermont this choice is a moral one make no mistake the function of the Green Mountain Care Board is to ensure the adequate provision of health care in Vermont and to ensure the transition to a universal health care system we sit here today in a room far away from nurses who are fighting for safe staffing from people who are dying that is the consequence of your decision tonight and over the course of these humans please don't forget that I just wanted one more time to give somebody the mic come on forward it dawns on me that I shouldn't miss an opportunity to do a quick public service announcement about a whole other aspect I've been a chemical engineer and that is sort of connected to the health care advocate office and that is to being a party status to issues like whether insurance companies rate their rates we have a call center so that people are having issues for themselves in their families managing this very complex often unfair health care financing system and you'd think I'd have that committed to memory. But you can also look us up on the web. I've got a great, dedicated staff of incredible advocates who are there every day working hard for people. One more time with the number? Yes, 800-917-7787. Thank you. Thank you, Mike. May I ask a quick question? How do we email our, if we do written testimony? So the best email address Christina? GMCB. So again, it was gmcb.org-vermont.org-vermont.gov. Does anyone else wish to speak? Yes. I said yes. We will all be testifying, a lot of us. I wasn't going to, but I thought I should come up and say, I hope, thank you. I hope you heard everything that everybody said. It's really important. That's it. Health care is a human right. Get with it. Thank you. So unless someone else wishes to say anything else, I don't know, Mark, if you wanted to elaborate further on what you were saying earlier, or if you just want to leave the written record as is, or? I can email it to the board chair. And I think it would be useful to have a more in-depth conversation with the board to understand those elements because I think there are some clear opportunities where at least we can start to connect those processes. Thank you, Mark. And we will stay till 6.30 in case someone comes in late. We do understand that it's not often easy for people working in Vermont to go get to these meetings. So we will continue to be here until 6.30 because that's what was advertised at. We don't want anyone to drive a long distance in there.