 I think, I think we have everyone here tonight. So I'll call to order the Green Mountain Care Boards meeting of July 24th, 2023. I'd like to welcome everyone to today's public comment forum on the Qualified Health Care Plan filings, both the individual and small group markets by MVP and Blue Cross Blue Shield. So the care board last week conducted two rate review hearings, one for MVP and one for Blue Cross, and both companies had individual and small group rate submissions that they put before the board. And today we're happy to hear from any member of the public on their concerns generally. The purpose is really to focus on the QHP filings that are before the board. But if people have other feelings about the health care market or other insurance plans that they have, I'm certainly open to hearing those as well. I want to provide a little bit of background. Every year around this time, the care board reviews premiums, which are also called rates from health insurance companies with small group and individual or family health plans. And that totals about 68,000 Vermonters. So a lot of Vermonters get their health insurance from Medicare, a lot from Medicaid. And then there are large group filings, and then there are also self-insured plans. But today we're just dealing with the small and individual group qualified health plans. The premium requests here are specific to Blue Cross and MVP, and they do not impact the other types of health insurance, such as Medicare, Medicaid, or self-funded employer plans. Information about this year's premium requests can be found on our website under today's meeting information or at raterview.vermont.gov. The care board's review process is established in statute and directs the care board to consider whether a rate is affordable, promotes access to high-quality care, as well as whether the rate is actuarially sound and protects insurer solvency. In evaluating premium requests, we consider a variety of data, including the opinions of its actuaries, the care board's actuaries, the Department of Financial Regulation, and data presented by the Health Insurance Carriers and the Office of the Healthcare Advocate. We also consider and weigh public comment. And I want to recognize that so far we've received over 200 written public comments relating to these filings. And I know that I myself and I think my other board members read every single comment and we appreciate people taking the time to send us the thoughts. They're often touching and moving and impactful. Sometimes the truth is they make me sad or upset or I want to do something different. They really influence how we think about problems because they give us a perspective of the people who are having to pay them. The rate increases. So I also appreciate everyone taking the time to attend the public comment forum and to provide input this afternoon. Just a couple quick housekeeping issues before we get going. But I'm the chair of the care board. My name is Owen Foster and I'll be facilitating the public comment forum. Anyone who'd like to make a comment can do so by using the raise your hand function on Teams. Or if you're on a phone only, you can ask to be called on once we make it through the raised hands. Commenters should please identify themselves prior to making a comment, including whether you have any affiliation with any of the regulated entities. So that would be either the hospitals, the ACO or one of the insurance companies. We're scheduled to go until 5.30 but we're happy to stay longer so that everyone has an opportunity to be heard. And Cassidy is our court reporter today and she'll keep a record of the comments made at the meeting so that we can review them later. We also have the healthcare advocate here. Mike Fisher is the healthcare advocate and he has a couple of other folks at work with him. And he's very helpful for people who show up at these public hearings. And sometimes there's follow up that he can do to assist if there's anything needed. And maybe at this time it's a good point for the healthcare advocate to introduce themselves. Thank you, Chair Foster. My name is Mike Fisher. I am the healthcare advocate and there's a couple of other members of my team here. I will just say briefly, you know, the purpose of this meeting is for the board to be informed by people. I always feel the need to say that the healthcare advocate's office is available to all Vermonters in sort of a different capacity than our capacity, our official capacity here in terms of being a part of the right hearings. It's more our capacity to help people out. And so I'm just going to go ahead and say our phone number 800-917-7787. It doesn't detract one bit from the power of a public comment about whether the ACA can help out. Just want to make sure people know that we're a resource to you if you need it. Thank you, Chair. Thank you very much, Mr. Fisher. So that's all I had. And we're excited to hear from folks and get the feedback. And I see a few hands raised already. So I'll just turn to folks in the order in which their hands are raised. The first is Audrey. Audrey, please go ahead. Hi, can you hear me? I can, yes. My name is Audrey and my pronouns are she, her. And I'm a lifelong Vermonter currently on Medicaid. I've availed myself of insurance plans, both with MVP and Blue Cross Blue Shield through Vermont Health Connect in the past. So I'm sure you know, and this is information that I'm learning that Blue Cross Blue Shield and MVP are structured as nonprofits. So they avoid words like profit and shareholder. However, I was shocked to learn that Blue Cross had revenue of almost a billion dollars last year. Nearly a billion dollars. And that really every year, Blue Cross Blue Shield and MVP, they come to the Green Mountain Board asking for more and more and more at the expense of the most vulnerable Vermonters. My understanding is that often the argument is about maintaining some reserves, which is a luxury that Vermonters don't have. They hoard this money while they provide inadequate and overpriced health care, which makes it impossible for many Vermonters to afford insurance, leaving in their wake dead, disabled, and suffering folks, your neighbors, our neighbors. Right? It's interesting to hear you say that the board is tasked with ensuring that the health care is affordable and that it's high quality. It's neither. It's neither. And I can hear it in your voice that you know that. When you talk about the sad stories that you're hearing and the painful stories that you're hearing, and it's a broken system that we have to come before the board and grovel and tell our most personal health stories to beg you to not allow these increases, to not allow the health care, the health insurance companies to hoard money. Our salaries can't keep pace with these increases. Many Vermonters are losing our Medicaid, including myself. If these increases are allowed, I'm going to be a 60-year-old working uninsured grandmother. Audrey, it sounded like you may have cut out and I just wanted to make sure he didn't have any other... Yeah. So I just want to... I'll wrap up. I know other people want to speak too. Take your time, please. Well, I think I'm not sure when I cut out, but in saying that many Vermonters are going to be... a multitude of Vermonters are going to be losing Medicaid, their Medicaid coverage, and I'm one of them. And if these increases are allowed, I'm going to find myself very soon as an uninsured working 60-year-old grandmother. And so I appreciate the time the board puts into this. I know that the Blue Cross and MVP make sure they have your ear. I'm asking you, I'm asking you to prioritize Vermonters, the most vulnerable Vermonters, when you consider and make these decisions. Thank you. Thank you. And I was remiss to not introduce the rest of the board here with me tonight. So I said my name and my position. We also have Robin Lunge, who's a board member, and Dr. Dave Merman, who's a board member. A number of the board staff is on, and including our executive director, Susan Barrett. So if you see some of us, that's who we are. Next, Amy Lester. Hi. Can you all hear me okay? Can, yes. Great. Thank you. My name is Amy Lester and I live in Plainfield, Vermont. I'm a member of the Vermont Worker Center and part of our healthcare is a human right campaign. I helped in the fight leading up to and the passing of Act 48, the bill that required the formation of the Green Mountain Care Board to demonstrate transparency and oversight for the universal healthcare bill that was passed. It's a bill that still needs a funding mechanism and as you could probably tell, I'm hoping that Act 48 will come to fruition. I'm also here because I am personally affected by any kind of health insurance increases. I recently accepted a job that provides healthcare and I moved from my past insurance plan through Medicaid. The amount of money I make in my new job is quickly being eaten away by co-pays, prescriptions and deductibles and now a rate increase again for Blue Cross Blue Shield is more than I can handle. I like many of my neighbors, friends and family are being squeezed to death literally and if the rising cost and debt doesn't and if the rising cost and debt doesn't get you then the stress will. I say no to rising insurance costs. I say yes to universal healthcare and I thank you for your work and I hope that each one of you will join our campaign for healthcare as a human right and that these rate hike hearings can become obsolete. Honestly, I'm tired of coming to them but and it wouldn't make your jobs obsolete because if you look at the bill, there's lots of reasons why this board would be useful for transparency and it's nice to see you Robin. You've been around for a while. Yeah, thank you for listening and I'll submit my testimony and writing as well. Nice to see you too, Amy. All right, thank you Ms. Lester. Jennifer Decker. Hi, if I cut out it's my internet connection but you could call on me again when I'm back if that happens. Thank you for hearing and listening and responding to our concerns. My name is Jennifer Decker. I have a graduate level of education and I worked in mental health in Vermont. My pay was low because I had to cut back hours due to disability. Cutting back wasn't enough and I'm no longer able to work. I've had a rough year transitioning to Medicare. Recently I found out about the guarantee issue period that allows me a brief reprieve as long as I'm still on Medicaid but I'm going to be dropped from Medicaid sometime between now and February. It took me six months without any accommodations for my disabilities to understand my situation which was incredibly stressful and has hampered my recovery in health. Once I'm ejected from Medicaid I will begin to pay something in the ballpark of 35 percent with my less than $2,000 monthly income for health care costs because of needing dental vision and hearing coverage, drug coverage, a medic app plan and trying to afford my additional health care costs. Ironically I was offered the opportunity to get more money in food stamps because of all my incidental health care costs but I'm not allowed to spend the money from the food stamps account on my health care costs. Universal health care would solve this and would give everyone the greatest chance of giving back to our community. Raising the rates would put me in the position to utilize community supports for dental and hospital costs and I need a surgery. I know that you just said the piece about people on Medicare won't be affected by these rate increases but I'm unclear as to whether it would affect me. The Blue Cross Blue Shield Medigap plan that I'm considering is one that already is outside of my budget. I have not once in my life gotten a raise of 12.8 or 15.5 percent. I have not made more than $36,000 a year. I'm curious what kind of investigation you do of the justification for these costs. Do you look at their spreadsheets? Do you delve into their budgets? Do you agree with the types of things that they're spending money on? Over nine years Blue Cross premiums have risen by over 90 percent. How much of this money is used for overhead unrelated to our actual care? How much money and human resources could we save if we had a universal system that is straightforward and not profit-based for the few but rather benefits everyone? I looked up the definition of the word care. Care means provision of what is necessary for our health, welfare, maintenance, and protection. Care is serious attention and consideration applied to doing something to avoid damage or risk. Care as a verb is feeling concern or interest and attaching an importance to something and looking after and providing for the needs of the people or the other forms of life that are impacted by our decisions. I care about and feel concern or interest and attach importance to the voices of the people that I'm hearing today speaking up for universal health care and speaking to stop these rate increases. Given the relative amount of social privilege that I have, I can't stand to think what this is doing to the families and children losing coverage. I care for them too. Let's all speak out against Medicaid cuts and premium increases. Thank you for hearing, listening, and responding. Thank you, Ms. Decker. I will respond a little just give a little bit of background I should have covered earlier. Your question about how the board reviews the rates I think is a good one and I should have provided a little background on that. So every year there's a written submissions to the board explaining what the rate request is and then explaining why in the insurer's view it's an appropriate amount. The board staff then reviews that, analyzes it, and we conduct hearings. We conducted hearings last week where the health care advocate and the carrier present witnesses and there's cross examination and then the board, all five board members ask questions of the carriers including cross examination of the witnesses to make sure we have the information we need. One of the main points that does come out of that is an assessment of how much of the money of that revenue is actually going to cover claims. A big part of what an insurance rate is is how much they have to spend to cover the cost of care. My wife just went through very lengthy, expensive care and they had to pay over a million dollars I think for her care. So that would be something that they would look at is how many people like Owen's wife do they have and how many claims they have and what do they cost. So as the cost of the care that they're providing increases that influences the rates. So pharmaceutical costs go up that influences rates. The number of people submitting claims and the volume of claims and the costs for those claims are big drivers of rate. So I think it was, I think it was, I don't have the number in front of me but somewhere around 90 percentish of the revenue they receive is paid out to pay the claims. And so the other parts of the care board looks at amongst many others but we look at the administrative costs and the overhead costs for the carriers and we look at benchmark data for how our carriers compare to other carriers nationally. And those are important factors that we think about when we decide what the rate, if they established their, if they met their burden of proving that the rate they submitted is correct and if they didn't there can be adjustments downward because, because they did or did not or sorry if they did not. I hope that helps sort of give some information like how we do this and what we look at and then the other things we do look at are the public comments and some information submitted by Mr. Fisher and the healthcare advocate's office on whether the rates are affordable, if they're promoting quality, how the money's being used, all that information is top of mind for us as we as we make these calls. And could you clarify the question about Blue Cross Blue Shield and the Medigap plan? I don't myself know for certain the answer to that. We may have a couple folks online that might. I think the answer is that these rates do not touch Medigap, but I should be certain by checking with someone. Yeah, I'm getting head nods. Robin or Eric, do you want to go ahead? Yeah, the Medigap plans are actually reviewed by the Department of Financial Regulations. So those are not plans that we the board reviews. So these rate increases would not apply to those plans. I don't know when those rates get filed with DFR or what might have been filed there. I don't know if Eric knows, but I think you're muted, Eric. It's variable when the carriers file. And so there are many more plans in the Medigap market than connect markets. I can't actually say. And also that Mike would know. I'm seeing Rebecca Heinz. I don't know whether Rebecca came on camera to answer that question, but you're muted, Rebecca. Hi, this is Rebecca Heinz from Blue Cross Blue Shield of Vermont. We have filed rates. I don't recall what they are, but they do go through DFR and they become effective the first of the year. And to Eric's point, there are many carriers in the Med Sup market. And DFR publishes a nice price guide on those plans as well. Okay, thank you. Next, Carly. Hi. My name is Carly Abrams. I share the pronouns. And I work for Washington County Mental Health as well as a volunteer for the Vermont Worker Center. And I second everything that's been said so far as well as add that. So I mean, I work in community mental health and I cannot afford to see to get mental health therapy. My employer has a plan and I'm on it. However, the deductible is thousands of dollars that before I can use any services, I paying thousands of dollars out of pocket and never receiving any benefits despite my company paying in and myself paying in. So I think that's an important factor that there is so many people who are paying into insurance and required to have it and still not getting any of the benefits from it. And there's so many claims that are denied. Yeah. And I basically have to pay everything out of pocket even though I'm working in community mental health and making far less than $20 an hour as a career. And part of the claims being artificially or the claims are artificially inflated. I mean, that's part of the whole system that they're not talking about when they say how they had to pay so much out of pocket is how much of that is going to bureaucracy and to billing and the cost of things that are taking money away from the people and giving it to other health care profiteers. I just really want to emphasize that they're not giving back to the people. This is whether they're a nonprofit or not, whether any of these are nonprofits or not. They are corporations that are profiteering off of the people and leaving us desperate and unhealthy. I think that's all I have to say. Thank you for saying it and thank you for working in mental health in an area that helps us keep our costs down in the state and an area where we sorely need people like you doing your work. So thank you for participating and thanks for the work that you're doing to help our system improve. Carly, I appreciate that. And Manny Menzbach. Hi, can you hear me? I can, yeah. I'm having some trouble with my internet. We have thunderstorms in the area. So I have been going in and out. I'll do my best. Can you still hear me? I can. Yeah, you can hear you and see you. Great. A knife, Rose. I jinxed it. I think in my back, I went out. You're good. Yep. Okay. I'll try and be concise. I'm a mental health professional for many years and a meditation teacher and the stress that I think I'm out again, huh? You're still going. Oh, okay. I see an enormous amount of stress from people in terms of their healthcare. I was recently spent a brief amount of time in a European country named Denmark, where healthcare for all is a given. And folks, there are a gas that what we put up within our systems here in America. The stress levels are so much lower. And as much as I appreciate that you folks are trying to do a sincere review and do right by people, I have to say that I find these hearings to be somewhat of rearranging the deck chairs on the Titanic that there that really the function of these hearings is and the rate increases that are inevitable are to determine how many people are going to get screwed how badly. And I'm waiting for the day when I when I can come to one of these hearings, we're actually discussing rate cuts instead of rate increases. I'm really looking forward to that day. The fact is that healthcare for most people in most working people in Vermont is getting more inaccessible, more unaffordable, that as others have said that the wages and salaries are not keeping up with healthcare increase rates. And frankly, the charter of the Green Mountain Care Board, as I understand it, when it was established was to ensure that all Vermonters have access to high quality healthcare, not to preside over the inevitable creeping increase of rates that put healthcare more out of out of reach for most Vermonters. And when you were talking chair about the reviewing the the expenses of the healthcare organizations and stuff built into that system is paying healthcare executives exorbitant salaries that are far, far beyond what what the average Vermonter makes. So it built into the system of reviewing these rates. It includes kind of prioritizing these built in salaries of these supposed nonprofit executives over the needs of poor and low wealth folks. So I consider this this hearing to be in some way similar to the kinds of hearings that are going on across the world around climate change, where people of, you know, of people who are good people are trying to determine what to do about climate change, but but not keeping up nearly as fast as needs to in terms of what what needs to be done to actually deal with the problem. And the same is true of healthcare. So it's kind of a it's kind of an ongoing violence to most people, most working people that is considered polite and acceptable, but it's really a violent system that that excludes so many people and and is getting worse, not better. So I wish you would put your energy behind really reforming and you know, creating a system that is more fair rather than managing a system that's fundamentally broken and unfair and violent. Thank you. Thank you. Audrey, I see your hand is raised. I think you spoke before, but do you have more? I have some questions. Yeah, so universal healthcare, healthcare for all. I'm sorry, Chairman Foster, I didn't hear that question. Yeah, I think you broke up for a second. You were saying could you start again please? Yeah, can you hear me okay? I have thunderstorms happening where I am too. So I hear folks talking about universal healthcare and healthcare for all. What is the relationship of the care board to reform? That's a really good question. That's one that comes up and I'm asked about quite a lot. So there's some historical role and we currently have a role and I guess the easiest way for me to sort of answer that question is universal healthcare to be passed would have to be something that goes through the legislature and then to the governor. The care board's tasks are set out in our statute as to what we are supposed to do currently and what we're authorized to do and so we only work within those parameters of our statutory authorities. And so in terms of healthcare reform, our main statutory efforts right now are focused on coming up with and creating hospital global budgets and supporting and collaborating with the agency of human services in negotiating a new all-payer model agreement. So currently Vermont is in the first all-payer model agreement and that's what created the ACO structure which was intended to drive down costs for Vermonters and lower the rate of growth in our system. That agreement is coming to an end pretty soon and the state is engaged in new negotiations with Medicare to come up with a new all-payer model and the care board is not leading that negotiation but we work with AHS who is. So I would say currently the primary focus of our reform efforts on a day-to-day basis are really supporting that work and also trying to create global budgets. The idea behind global budgets being if a hospital has one amount of money they can allocate it and use it in the way that they see best for the population's health and what that means is really currently in a fee for service market people are driven by where they get more margin and where they can make more money. So you see a big focus on dermatology or orthopedics where there's high margin practices and we're concerned that there's less money going to preventative care, mental health care, substance use disorder care, primary care and so under a global budget those financial levers will be different than they currently are. So I'd say that's our primary effort right now in reform. And okay. All right that prompts more questions but I'll save that for now. So another question I have is what would get in the way of the board denying the increases being requested? Good question. I think the answer is nothing. The only thing that would get in the way is if we feel as a board that they have met their burden to show that they're affordable, they promote quality, they promote access and they protect and ensure solvency. So that's what gets in the way. If they've accomplished that then we would vote to support them and the rates would be awarded. So I'll just speak a little candidly and frankly here. I think the biggest thing that we need to think about is what's driving the rates higher. Is it insurer greed? Is it executive salaries? Is it excessive increases on the rate? And if it's not those things then what is driving the rate? Is it primarily the inputs? Is it the costs of the claims that they're supporting and paying for with this money? And if they are paying that then you actually have to look more at what those costs are and how those costs can be contained before they feed into the rates. So okay, great. That's helpful. And so I'm sorry to interrupt you. I just wanted to note that Amy had put a note in the chat that there may be other folks on the phone who don't have a raise your hand feature. Of course. I apologize. Yes, I forgot about that. No worries. I just wanted to make sure that we knew that. Okay. You know what, Robins? I'll have Audrey finish her questions and then I'll go and make sure folks on the phone. Yeah, thank you. Sure. Well then there's a whole question of what's a reasonable executive salary and what's a reasonable amount of reserve, right? And so I feel like when the perspective is to ensure the solvency of the insurer and that takes precedence over the affordability even though, you know, in theory it has an equity about it. I just think that, you know, we're in it's a losing battle. Yeah. I mean, I would and I'm just one board member, keep in mind. So, you know, it takes three of us to to make any decisions that Dave or Robin wants to speak up. I'll welcome them too. But insurer solvency is really important. It is one of the factors we look at because it doesn't help anybody if they have insurance and their insurer goes away, right? But when we're getting care and if the insurer can't pay it, that's a really bad thing for the system and a bad thing for Vermonters. I agree that affordability is also really important and the affordability is important for solvency too, right? The lower number of members that an insurance company has, the less solvent they are, right? Because their costs get really high. So the whole premise of having an insurance company kind of depends on it being something that people can afford so that you actually have the membership you need to sustain the operation. In terms of executive salaries and reserves, we do look at reserves. We look at where they are, how much they need. There are guidelines. DFR, Department of Financial Regulation has ranges that they deem acceptable. Our insurance companies are below those ranges. They are there below those. In terms of executive salaries, the care board has looked at this in other contexts. We've made decisions in other contexts on executive salaries. It is important to make sure that the amounts being paid are appropriate. At the same time, we want our insurance companies and hospitals and ACOs to be able to retain and recruit the best. That doesn't mean we want exorbitant salaries and I think it's an appropriate thing to look at and make sure it's fair because I'm paying insurance rates too. But I have great insurance. I'm very fortunate the state gives us very good insurance and not everyone gets insurance that we're really privileged to get. They should be fair and market-based and they shouldn't be exorbitant. I agree with that. I would just offer that when all the folks in the decision-making positions have safety nets, it's challenging for us to feel so powerless. Then I'm just going to stop because I know I want other folks to have a chance. I know there's only 15 minutes left and I want the folks on the phone to have a chance. Thank you for answering my questions. We can go later. I have no problem continuing this meeting as long as we need to to hear everybody. Don't let the time constrain anyone. Your point about the safety nets, I think about that actually myself quite a bit. I'm not on the exchange. The other board members are not on the exchange to my knowledge. I don't think our staff is either. We have a different deal with our employer. That's why it's important to do these hearings to really understand what this means to everyone who is because we're not. I'm glad that you mentioned that. Not only is there a lack of socioeconomic diversity on the board, and I would assume the staff, there's a lack of other diversity for folks black, indigenous people of color who are even more vulnerable than the white than as white than myself as a white person. Thank you. Thank you for hearing me out. Thank you for speaking up. Michelle? Hi. This is Michelle O'Donnell in Winooski. I think I echo other people's frustrations that we keep having to come back year after year and beg for to not have to pay more money. I think this year feels particularly unique with so many people, thousands of remoners getting kicked off of Medicaid and being forced onto these plans and then to have that happen and then see a 15% increase in premiums just seems inhumane in so many ways. For people getting off of Medicaid and going on to these plans, the subsidies that are available are not enough to fill the gap. I think in the short term, the best thing that you can do is do everything that you can to lower these health care costs, not raise them. You know, your board is supposed to, one of the goals is to reduce health care costs, not to keep insurance companies in business. And Blue Cross Blue Shield can, you know, if you were to reject their request for an increase, they could go back to Big Pharma and the hospitals and everybody that they are paying to negotiate. But why would they if you keep just accepting these increases and approving them? So I think it's never, yeah, they could use a little more, I don't know, encouragement doesn't feel like the right word, but, you know, they need more, you know, incentives to be decreasing their costs as well. So I think, you know, it's never the right time to increase costs, but especially right now when people are losing their Medicaid or in the middle of an economic crisis, people are still, you know, mucking out their houses and going to be putting up a fight with FEMA. This is not the time to be increasing premiums. And I think, you know, the obviously you all aren't able to flip a switch and give us all universal health care. But I think that that's you know, the solution to this is that everybody can have free and equal access to health care that's paid for with public tax money. So I appreciate you holding this space. And I hope that you think about all the people that are sharing their stories when you're, you know, deciding what to do. Thank you. Thank you, Michelle. I'll turn to folks on the phone. Does anyone on the phone have a comment? Hi, can you hear me? Yes. Hi, my name is Becca. I am, I live on White River Junction, Vermont, and I'm also a member of the Vermont Worker Center. You know, I just wanted to say that already my health care, I had MVP and now have Blue Cross Blue Shield from a new job that already my health care doesn't cover my birth control and raising premiums while not providing more accessible care seems pretty backwards to me. They're going to raise the rates and I'm still not going to be able to have my birth control covered. I'll be paying more for the same standard of abysmal care on these plans. I also wanted to speak to some of the questions about what is the fair executive salary and for clarity and transparency on this call. I'd love it if the board members, if they know the salaries of some of the top executives at Blue Cross Blue Shield and MVP. I looked them up online, but like Google searches are not always correct. I can share, but I'd love if people have the actual data to correct me. Um, so like I found that Scott Serrata, who is the president and CEO of VCBS made 20 million in 2021. That doesn't, I think there's like many questions about what is a fair executive salary to attract top talent. That is, you know, way beyond the moral ambiguity on my book. Um, beyond that, I know that MVP in 2020, and this is from looking up their 990s forms online, made an in a net income of 25 million, and have been making in the clear around 20 million in that income for years, going back to their 990s. And beyond that, I wanted to second what has been said about the inhumanity of raising the premiums during the multiple crises that Vermonters are experiencing. The prices of housing affordability, rent in affordability, the loss of health care with a Medicaid cut off, cost of living and inflation increases. And on top of that, as Michelle mentioned, there are thousands of Vermonters losing their businesses, their income and their home due to the flood. It's currently thunderstorming where I am. And I've been at mobile home parks over the past week and seen the devastation that many of Vermonters are experiencing. And I just wanted to really urge the Green Mountain Care Board to reject any increase of the premium. And I believe that's a callous in a moral act to raise people's health care crisis, to raise people's health care prices during these moments of compounded crises. Thank you. That's all. Thank you. I think 20 million should get a pretty good CEO. But putting that aside for a second, I don't think that is, I think that's maybe Blue Cross nationally or a different Blue Cross. I don't think that's the Blue Cross folks here. I've never actually heard that name myself. And just for clarity, I don't think we actually have that person within our regulatory role here at the care board. I think that's, there must be somebody else. But 20 million should get you a pretty good CEO, you'd think. Okay. Anyone else on the phone? Or Ms. Hines, I saw, I know you're at Blue Cross. I saw you come on on the screen. Kota is the former president of the Blue Cross Blue Shield Association, a national, national organization. I'm sorry, we didn't catch that name. It's the Blue Cross Blue Shield Association. It's a national organization. No, the name you said. The name that Scott's wrote, that's the person that was just referenced. Thank you. Is there anyone else on the phone with any comments? Hi, can you hear me? Yes, sir. Go for it. So thanks. My name is Michael. I'm calling from Montpelier. And I, yeah, what I want to say is, is this, I appreciate that the Green Mountain Care Board exists as an entity. I would like to think that they, you are in some ways shielding us from what otherwise us, meaning Vermont citizens, what otherwise might be absolutely egregious. Rate increases. But as it stands right now, I really echo what others have said in particular. I, I haven't seen arrays in years, let alone arrays of 12 to 15%. I work for a small business, which is the kind of, the kind of business that America and Vermont loves to tout as being the kind of business that keeps us going. And it is also one of many across Vermont that does not provide health insurance for its employees. And so I purchased this through the marketplace. I make slightly over the cap for Medicaid, but do not qualify for significant tax rebates from the state or federal government. And so if Blue Cross, my current insurance provider is allowed to keep increasing their rates and increasing their rates, I and many others, some of whom have mentioned so on the call today, will have to go without health insurance in order to keep up with other expenses. I do not believe that that's the Vermont that we want. I don't believe that we take care of our own by letting large health insurance quote unquote nonprofit corporations deprive our citizens of their health care by pricing them out. One of GMCB's core values is that it is accountable. And I and others are here to hold the GMCB accountable to us, the citizens of Vermont. Allowing further rate hikes at the expensive Vermonters does not contribute to GMCB's stated vision of a sustainable and equitable health care system that promotes better health outcomes for Vermonters. I do want to echo what I've heard from others that I hear the humanity in the board and you know I value all of the time and effort that that goes into what you do. And I also, as others have said, ask you to reject these increases because of the timing because of literally everything else that everyone has said. It's just not equitable. It's not affordable. And with these increases, there is no better health outcome available to Vermonters. Thank you. Thank you very much, Michael. Anyone else on the phone? Chair Foster, this is Susan Barrett. Could we just announce that folks are on the phone and want to unmute? They can hit star six just to make sure they can get through. Thank you. Thanks. My name's Griffin Trumway. I keep unmuting and keep being muted again. And it's okay, but every time that happens, I miss a little bit because the voice tells me that I've been remuted. My name's Griffin Trumway. I live in White River. I'm another member of the Vermont Worker Center. This isn't my first Green Mountain care board hearing. I've been here probably for seven years now, staying sort of the same thing. And I need to be honest. This didn't feel good. I had written something before the hearing and I had to rewrite it because at the beginning, you said that our stories had a meaningful effect on the process. And I've been here year after year after year after year to let you know that this isn't working and nothing has changed. And in fact, not only has nothing changed, but today you just said that the real purpose of the rising rates is to make sure that the insurance companies are still able to exist. I'm on main crisis. I'm a teacher. I can't afford my housing. I was on Medicaid, but I got kicked off in July as part of the redetermination hearing because I was laid off during the pandemic. If things don't change for the better, I'm going to need to leave the state just to be able to afford to live. The care board has a responsibility. It was given to it when it was created in 2011 to develop a financing plan for universal healthcare. And I'll let you know that developing a financing plan for universal healthcare seems very dissimilar to making sure that insurance companies still exist. It's incredibly disheartening. It's incredibly sad. It almost makes me vomit to know that the care board cares more about private insurance companies existing than the people that are dying because they don't have access to care. Not just that the care board does, but that any human dean on this planet would care more about the private insurance companies existing than the people dying from lack of care. This year in Vermont, we're in as much of a crisis as we've ever been. We've got a cost of living crisis where food, housing, healthcare are no longer affordable to most people. The staff on the Great Mountain Care Board make almost twice as much money as the average wage in the state. And most people, many people, make below the average wage. I make below the average wage. Come we're coming out of a pandemic, we're seeing lasting social and emotional effects, we're mourning our dead, and we're mourning our breaking, our broken social ties. My community is not the community that existed before the pandemic. And now we have a flooding crisis where people are across the state who clung to stability through purchasing a mobile home in Ludlow, renting apartments in Barrie now don't have a home to go back to. All of this while 30,000 for monitors, including myself, being kicked off of our only access to real, meaningful, affordable care, Medicaid. These rising rates are killing people. Premiums and barriers to care are killing people. Poverty is killing people. The board has a goal that was set out to our by the legislature in 2011 to develop a financing plan for universal health care to save lives, to prevent people from dying. The board has a choice to make. Which side are you all on? That's why I'm going to repeat what Amy Lester said, no derising health care, no derising insurance costs, yes to universal health care. Thank you. Thank you very much. I would, I should clarify, I don't think that care board's review of this, the primary is to ensure insurance company exists. I think that is one of the factors we look at. It's affordability, promoting access, promoting quality and insurer solvency. I don't know that one is really greater than the other that the others don't exist. So I think that those are the things that we look at, insurer solvency. Can I ask a follow up question? If denying a rate increase would mean a health insurance company was no longer solvent, would you deny that rate increase for the benefit of for monitors to make sure health care is affordable? Truth is, I don't know the answer kind of in the abstract. I think it would have to look at all of the, like look, if the rate was affordable and there are things that you can look at to consider that. Would I approve a rate increase of admin insurance solvency and would promote access and improve quality and was affordable? Yes, I think I would. It is one of the factors we need to look at because it's really problematic if people pay for insurance and the insurance company is gone, right? That would be really devastating. So I think that insurer solvency, it's in the statute. It's one of the things that we do need to consider. And that is something that's important to people, just like the affordability aspect that you're talking about. I don't think one should really subsume the other. I think they're both quite relevant. But I understand your point and I understand your frustration completely. And I know where you're coming from. So I'm glad that you raised the comment, but I just wanted to clarify that personally in my view as the chair of the care board, I don't think that's the only factor that we look at in terms of insurer solvency. And I think you can see that it might not feel like that given the way the rate increases have come pretty fast and furious over the last several years. But the RBC, the risk based capital, that's the amount in reserves that our insurance companies have, is getting lower and lower every year. So I think you can see that the board has been trying to make some of that balance by making cuts for affordability to the rates that are proposed. And that has eaten down some of the risk based capital. So it might not feel like that. I know it doesn't, I get it. But I think it is there and we'll see where it ends up going this year. Okay. Any other commenters on the phone? Ms. Gutlin, I see you have your hand raised. Yeah, thanks. I submitted comments. So I'm just going to add a few things to that. And for the record, I'm Sharon Gutlin. I'm a business owner of the rehab gym. I'm a provider of physical therapist. And I will speak about the patients. I'm on the front lines, right? We see the patients coming in. And I will say that affordability isn't just in premiums. You have to pay the deductible and then people pay every time they come in with copays. And it's getting more difficult to stay in physical therapy for the recommended length of service because they just can't afford it. So even if they have insurance, they're paying premiums, they're still paying a lot of money into the health care that they receive. And then I want to speak about my employees who my providers have doctorate degrees and $100,000 of debt. And when I started the business in 2003, I was paying 100% of the premiums. And the insurance rates of those premiums have doubled. And I cannot afford to pay anything more than $300 per person. So they are struggling. And I have to live with that. So I am seeing the face of struggle in patients and employees. And I wanted to just mention, as you know, I do offer a way to help people in chronic care. And I've been offering that for two decades. And for those that have been fortunate to have enough money to pay for it out of pocket because insurance doesn't cover it, I see people getting healthy, getting off medications, being healthy mentally because our minds and bodies are connected. So it's very real. And there's evidence to back it up. I just cannot get Blue Cross and Blue Shield and MVP to pay for it. So reform is not happening. It's pretty much the continuation of how health care has been. And it is actually getting worse because as anything broken that isn't fixed will continue to break down even more. So we have solutions. I encourage the board to encourage the payers to research into these options that they have not tried instead of just continuing on the same track. And I do want, lastly, I do want to see an executive compensation really tied to affordability. Maybe we really should wipe this late clean because if you look at it, those in charge of health care have not made this system better or in quality or affordability. So I'm after compensation that meets the goals, the missions that we all as people in health care put forth. Thanks. Thank you very much. Jennifer Decker. Thank you for allowing me to speak again. I am just wanting to say that I think we needed a new metric for what we consider the best for an executive. I think the best type of executive would be one who cared the most and therefore was willing to be paid much, much, much less. I wanted to also support what's been said about the inadequacy of our care system and the services that are offered because when I went to get my assessments, I was told by a professional that I have been under treated medically. I've lived in Vermont since 2004 and I was on MVP for a while. I was on Blue Cross Blue Shield for a while and now I've been on Medicaid and the end result of that is I've been under treated medically. I heard the question asked about what are the executive salaries of the executives in Vermont but I didn't hear an answer to that and I did not hear an answer to the Green Mountain Care Board's progress on developing a universal health care plan. I just want to thank my fellow people on the call who are speaking up for those who are dying or those who have already died. It's very frightening in this situation. Could you please answer the executive salary currently for MVP and Blue Cross Blue Shield and also what is the care board's progress on creating a universal health care plan? I don't know the executive salaries off the top of my head for MVP or Blue Cross. As nonprofits, they would file form 990s and I think they would probably file them also with their primary regulator. We just regulate these plans but I think that DFR is their primary regulator so I think they would be filed there. You can probably get them from them otherwise. I don't think I can answer that question. In terms on developing primary universal health care, that's not something the care board is currently tasked with doing and it's not something we are working on. If it were something that the legislature and the governor asked and we're trying to develop and assigned it to us, we would do it but currently that's not one of our duties before us. So would you all be willing to consider a new way of evaluating what you would consider the best type of leadership within health care and consider that recruiting people who do want to take the best care of Vermonters might be the right approach? I mean as one board member I think that your suggestion has a lot of value in that what we want to see is we want to see the state's goals are the people's goals and we want to see those aligned with how boards are paying executives of any of the entities we regulate. I think there's a lot of value to that right so that is something that we've started looking at and thinking about to make sure that people are working towards what the system wants and what the system wants is affordable accessible healthcare of high quality and so I personally think that that's a good way to look at executive compensation. Are you achieving what we want you to achieve not just growth of the of the place for growth's sake but is it actually driving down costs so I think there are questions to be asked in that realm. Thank you. Can I just add the insurance executive salaries I believe are on the DFR website so if you go to dfr.vermont.gov and on the left hand side there's a link to insurance sorry yep insurance then health insurance and report and in that has the annual reports for all the carriers and I think it's linked like it's on the when you open the report it's there's a section in each one I believe corporate officer and direct compensation. I haven't actually looked through them before but I was just informed of this so but that's something you could look at on the quick peruse they're quite different than the numbers we were talking about but I have I'd have to like look at them carefully to quote them. Mr. Chair if I could just jump in Mike Fisher healthcare advocate I just wanted to express appreciation for everyone who's showed up tonight and who's spoken and appreciation for and for everyone who's on the line listening in and appreciation for the board for listening and commenting so well I for one am not able to stay much longer so I wanted to express that appreciation and wish everyone a good night. Thank you very much Mike. Is there any other comment this time? Okay I'll echo Mr. Fisher's comment and that this is valuable and important to us and we appreciate you taking the time out of your lives to do this to inform us and share your views and thoughts. The one other thing I would say is that Susan is our public comment still open can people still submit public comment on the rates? Yeah okay so on on the Green Mountain Careboards website people are still able to submit written public comment which we'll review up until when we're deciding and even if they're submitted after we'll meet them after. So thank you everyone and Ms. Holland thank you for helping us tonight in preparing the transcript. 695,000 is the top executive at Blue Cross Blue Shield. And eight vice presidents making anywhere from $250,000 to $427,000 so the board finds those salaries acceptable. I don't think we've made that finding. Certainly they're not less than they were last year so last year the board found the salaries of the Blue Cross executives acceptable. I don't actually know the answer to that I think the budget was approved I think the rates were approved sorry not the budget but the rates. That wow it's difficult to hear it's difficult to believe that that they want to hear from us and that they are moved by our stories. Wow I believe you are moved and you'll do the right thing this year because when you don't it does affect our mental health out here. Ms. Bellova. Hi I just wanted to Laura Bellova staff attorney with the Green Mountain Care Board and I just wanted to make clarification about the public comment specifically to rate review. To be our rule has that comments are taken through 11.59 pm tonight. I'm sure we're always open to hearing comments and receiving comments but in terms of compiling a record for this year's rate review the cutoff is tonight at midnight. Thank you Laura. Okay is there a motion to adjourn? Move to adjourn. I'll second it but I think we just lost number lunge. I'm sorry I got kicked off because I'm too having thunderstorms but I managed to get back on so I assume Dave moved adjourn and I will second. Okay all those in favor please say aye. Aye. Aye. My apologies. That's okay we're adjourned thank you everyone and have a good evening. Thank you.