H.766 will add estimated 3-7% increase on top of “normal” annual premium increases.
by Rob Roper
Ask people why Vermont is unaffordable, and one of main the pillars of our unaffordability crisis along with education property taxes, the cost of housing, and energy prices is health insurance. These highly-regulated-by-our-legislature plans go up every year by amounts far in excess of inflation. For 2024 alone, the Green Mountain Care Board approved individual rate increases for Blue Cross and MVP of 14 percent and 11 percent respectively. That was over $1000 a year on top of already high premium costs.
So, this year our crack squad of Supermajority legislators dove right in to figure out a way to lower the future costs of Vermonters’ health insurance, right? You would be wrong! 180 degrees wrong! Far from working to lower costs, the Supermajority rammed through H.766, An act relating to prior authorization and step therapy requirements, health insurance claims, and provider contracts. And this bill, should it become law as looks likely, is estimated to tack another 3-7 percent cost increase ON TOP OF those already unaffordable double digit increases.
How does the bill do this? It eliminates insurance companies’ ability to require “prior authorization” for certain healthcare services. Prior Authorization is the process for discovering if a service is actually covered by the policy, is the ‘best practice’ for the patient, and if there is a more cost effective solution to achieve the same outcome. The benefit of the H.776 is that it would eliminate paperwork — the cost and time that requires – at the doctor’s office. While that is certainly a good thing, it comes at a significant cost to policy holders. The question is, is it worth it?
As MVP warned,
If the bill is enacted as is, Vermonters will pay significantly more for their health care, coverage options will continue to erode, and access issues will worsen. To our knowledge, no other state has taken such extreme positions on these issues. Our concerns are not hyperbole, and we cannot emphasize them enough on our roughly 27,000 Vermont members’ behalf.
Cigna chimed in,
There is no scenario where this costs less or some di minimis amount. Vermont families and small business are struggling to afford the high cost of health care, and H.766 will only compound these problems.
But, hey, these are greedy insurance companies, right? What do you expect them to say? Fair enough. So how about we get a neutral opinion on the likely cost of this bill before we pass it into law? Sounds reasonable. NOT INTERESTED! Says the Supermajority.
This…
PLUS this… is what the Supermajority is doing to Vermonters’ health insurance costs.
The Vermont Department of Financial Regulation warned in written testimony,
Estimates ranged from a 3-7% increase for members premiums based on the version of the bill as passed by the House (on top of any other necessary rate increases). These projections led us to recommend that an actuarial study be completed to better understand the cost impacts of the bill prior to enacting these consequential changes.
“Don’t care!” says Supermajority. There will be no actuarial study. The DFR letter goes on…
We remain concerned that to the extent that provider burden is ameliorated by this bill, it will be outweighed by potentially significant premium increases that will contribute to the diminishment of regulated health plans as employers and individuals seek lower-cost health coverage. DFR recognizes the importance of reducing provider administrative burden, but we also recognize the importance of cost control measures so that health insurance remains affordable. We believe that commissioning an actuarial study to evaluate the cost impact of Sections 2 and 3 of H. 766, prior to enactment or effectiveness, is a necessary and prudent step to evaluate the potential costs and benefits of the bill.
At this point our elected representatives have their fingers in their ears, eyes jammed shut, while repeating over and over again, “Lalalalalallala!” Necessary, prudent, and evaluate are not in their vocabulary let alone their governing philosophy.
Just so you know, a similar report done in 2023 for Massachusetts, which outlined the potential impact of eliminating prior authorization, concluded that commercial premiums could increase by between $600 and $1,500 per member per year, and Medicaid capitation rates could increase by between $270 and $1,100 per beneficiary annually if prior authorization were eliminated. So, maybe this is something Vermont lawmakers should take seriously.
Nope! In another blow to small businesses trying to provide benefits to their employees and individuals trying to make ends meet, the roll call vote in the House was 104-23 in favor of driving up your health insurance premiums. Senators didn’t bother to go on the record. It’s not their money after all.
Rob Roper is a freelance writer who has been involved with Vermont politics and policy for over 20 years. This article reprinted with permission from Behind the Lines: Rob Roper on Vermont Politics, robertroper.substack.com
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Categories: Commentary, Health Care, State Government
the increase in our private insurance was double of the cola increase of mine and my wife social security increase///
Health insurance is a myth, what are you insuring? It is a defined benefit plan that may allow you to use the dollars you put in and sometimes they match it or toss in a little more. Go for a health share but do your homework it will pay off!!!
https://www.zerohedge.com/personal-finance/visualizing-tax-burden-every-us-state
New Hampshire is starting to look pretty good.
In the name of centralized management (our dominant government ethos) the space between citizen and health care provider is filled with such obfuscation that we are now trapped in a dysfunctional system. Hope fades.
I am still baffled as to why these folks keep getting reelected. They spend like there is no tomorrow and to nobody’s real benefit.
Vote the spenders out!
If nobody runs against them, they automatically get re-elected. And think they have a mandate to do whatever they want because they’re so awesome and doing such a great job nobody saw the need to challenge them.
Rob and C. Burnham: You, and almost everyone, are missing the point. When 51% of the voters learn they can thrive by taking the property of the other 49%, we shouldn’t expect them to cut their own throats by voting for someone who will end their reign of tyranny.
The real concern, festering here in our government for a long time now, in the judicial, legislative, and executive branches, is, as Ben Franklin’s prescience warned back in 1787, that our “government… can only end in Despotism as other Forms have done before it, when the People shall become so corrupted as to need Despotic Government, being incapable of any other”.
Clearly, we are teetering on the edge of lawlessness that features tyranny, anarchy, and ultimately, chaos. It won’t matter how rich and powerful one may be. Everyone will suffer. Freedom is, after all, just another word for nothing left to lose.
If I knew how to stop this juggernaut, I would have said so long ago. I suspect this centralized chaos will end of its own accord, in the mire of bankruptcy and a complete breakdown in social norms.
Yes, we should keep calling out the tyranny as long as we can breathe and communicate with one another. But I’m afraid our only recourse now is to prepare for the worst – and speak as little about what that preparation may be, lest the tyrants (yes, our friends and neighbors, no less) circumvent whatever strategy you may have, in the same way they have already corrupted the checks and balances inherent in our Constitutional Republic for their limited, short term, and personal benefit.
In other words – make your own calculated alliances and avoid the tyrant’s wrath (incompetent or pure evil as it may be), like the plague it is.
“California has spent $20 billion over the past five years dedicated to the state’s homelessness crisis, including funneling money toward supporting shelters and subsidizing rent. Still, homelessness grew 6% in 2023 from the year prior, to more than 180,000 people, according to federal “point in time” data. Since 2013, homelessness has grown in California by 53%.”
Sound familiar? Apparently, the money was distributed to ‘qualified’ non-profit NGOs. And now it’s gone. And no one knows where it went.
Check out virtually any non-profit NGO in Vermont. Typically, more than half of their revenue goes to paying the salaries and benefits of its non-profit employees. You can do your own research by identifying the non-profit and looking at its IRS 990 filing.
Example: Founded in 1972, the Vermont Public Interest Research Group (VPIRG) is the largest nonprofit consumer and environmental advocacy organization in the state. It’s 2022 filing shows that $1.275 Million of its $1.461 Million in revenue was allocated to various employee wages and benefits.
More than 40% of Vermont’s workforce is employed in the utility, healthcare, education, and government sectors. Add to that their families, friends, and neighbors… our friends and neighbors. Our school boards are infested with retired school employees, school employees from adjacent districts, and employees of the other sectors listed above.
Anyone who advocates for responsible free-market economics is a threat to these people. And, clearly, they will do whatever is required of them, like the ‘teachers’ in Milgram’s infamous 1962 behavioral experiment, to punish those who ‘answer’ incorrectly.
It’s the dark side of our human nature.
My bet is the cost of cyber attacks and post-plandemic disabilities is hitting the health industry broadside in their bottom lines. We all ready know life insurance policies are paying out at unprecedented rates. We all ready know automobile and property insurance rates are way up. We all ready know Federal SSI/DSSI Medicare and Medicaid are insolvent but they keep printing currency to paper over it. (Federal spending a trillion dollars every 100 days?) All the increases are part and parcel of a failing system. No matter what Operation Tincup passes or proposes – the train wreck is unfolding and the hyper-inflated bubbles bursting. They know it and there is nothing they can do to stop it. They lost all control over it. They are now just following the orders of their Master. It won’t end well for them either.
Have you looked at any non-doctor’s office visit insurance paperwork lately? Let’s take a simple one – blood work. Seems like everybody has it done on a regular basis for this, that, or the other thing, so it makes a good example. Here’s one of mine for a full panel of blood work:
Cost of blood work billed by lab to insurance company: $1200
Payment to lab by insurance company: $726. Why? That’s what the contract between the insurance company and the lab states they will pay for this pre-negotiated service. My co-pay: $50 (I have met my yearly deductible)
So, if you’re following along, the lab has received $776, meaning the difference between what the lab charged and what they ended up with is : $1200 – $776 = $424. And who pays the $424? NOBODY. It’s typically written off as “Adjustment”. Why?
Let’s say I’m selling a car I know is worth $3500. That’s my bottom line. So what do I do? I put a sign on it that says $4200. And pretty soon, someone will stop, have a look, knock on the door, and ask me if I’ll take $3000 for it. Nope. How about $3500? Done deal. I get what I want, they get a deal, everyone’s happy.
Same with health insurance. So why not make them bill what they’ll actually accept (and are fine with) in the first place? Or even negotiate down from there. Find out what *their* bottom line is.
But that’s how a business person thinks, not a politician. To them, it’s not their money, so who cares, right?