• Group health plans will no longer exist for businesses with fewer than 50 employees.  Instead, your employees (and you) will purchase their insurance individually via a State-run insurance exchange.  The State will determine the rates, the plan designs, who can be covered and how much they will pay (it will be determined by personal income).  You will have three plans (gold, silver & bronze) to choose from.  It’s important to note that none of the essential ingredients (rates, coverage, etc) have yet been determined.
• Initial estimates show that in comparison to current rates (ie via BCBS-VT or MVP), the rates through the exchange will increase by a minimum of 18%, and probably far more than that.  You may be able to qualify for federal tax credits depending on your income level and whether we actually receive those federal funds.

I encourage you to read about this legislation and get informed.  I was at the town hall meeting in Wells on Saturday and it is no exaggeration to say that its effect will be far-reaching to all of us.  Please call me to discuss any of this.

Weekly Legislative Report
For the Week Ending February 17, 2012 

The House Health Care Committee voted 8-2-1 late Thursday afternoon in favor of an amended version of H.559 after weeks of testimony and deliberation on the session’s most significant health care reform initiative. The amended bill contains legislative directives governing state-specific construction of the health insurance exchange required by federal law, including a requirement that all benefit plans for individuals and small groups employing less than 50 employees be purchased through the exchange, that the exchange benefit options include lower-cost bronze plans in addition to the more generous silver, gold and platinum, a merger of the individual and small group markets (including the safety-net pool) into one pool, and a decision that the state won’t pursue an off-exchange basic health plan option to cover Vermonters with incomes between 133 and 200 percent of the federal poverty level.

The final committee vote came after consideration of several members proposed attaching other bills to H.559. Controversial proposals or issues requiring testimony were passed over, but the committee agreed to add provisions expanding the duties of the Joint Legislative Health Access Oversight Committee, addressing protocols for school sports injuries, an amendment to an existing prescribed products law, and an extension for a work group on claims edit standards.

Passed over were proposals deemed too controversial for H.559 but worthy of further consideration, including a prohibition on health plan mental health carve-outs, a VPIRG-sponsored bill to require enhanced insurer reporting on public websites, a bill requiring parity for primary mental health services, and a bill requiring payment for telemedicine. A proposal to amend last year’s midwives mandate was also delayed.

Prior to the final afternoon mark-up, brokers were invited to react to a proposal by committee chairman Rep. Michael Fisher to require broker fees be a direct transaction between the employer and the broker rather than including those costs in health insurer premium bills. The committee determined the issue was too involved to include as part of H.559, but they agreed that it should be considered later.

H.559 was referred Friday to the House Appropriations Committee for its consideration of the fiscal impact on the state budget of a provision in the bill to limit prescription drug out-of-pocket costs in health benefit plans. The full House is scheduled to consider H.559 on Thursday and Friday of this week.

Doubts resound at health care forum
By Brent Curtis
STAFF WRITER – Published: February 19, 2012

WELLS — There was universal opposition from residents who spoke Saturday at a forum to consider the pros and cons of a single-payer health care system in Vermont.

Close to 100 people packed the cafeteria at Wells Village School on Saturday morning, where a panel of speakers including two doctors, Rutland City’s treasurer and the commissioner of the Vermont Department of Banking, Insurance, Securities and Health Care Administration weighed in on the state’s ongoing efforts to create a universal health care system — including proposed legislation to set up a new health insurance marketplace, known under the federal law that authorizes it as an “exchange.”

While BISCHA Commissioner Stephen Kimbell, whose agency is tasked with helping to create the exchange and implementing a single-payer system once it’s designed, talked about the potential benefits of the health care reform initiatives, the other speakers and the roughly dozen members of the public who spoke all opposed the plan.

Kimbell spoke first by laying out the potential financial benefits of the state’s plan, starting with the creation of the exchange, which he said could bring upward of $400 million in federal funds that would be used to provide refundable tax credits to consumers in the exchange.

The exchange, which must be created no later than Jan. 1, 2014, in accordance with federal law, would encompass individuals and businesses with 50 or fewer employees, according to legislation recently introduced in Montpelier.

By 2017, Kimbell said, the state hopes to receive Medicaid waivers that will allow it to create and govern its own health care system with the goal of slowing down escalating health care expenses.

“We don’t think we can lower that $5 billion cost, we just want to slow the rate of growth,” he said. “Just increasing at a more modest rate would be good.”

But the other speakers said that not only did they doubt that the single-payer plan would lower health care costs, but they said it could damage the quality of health care provided in the state while ruining the economy as well.

From the projections Rutland Treasurer Wendy Wilton assembled using expense and revenue estimates from a number of sources, the state would find itself deep in debt if it pursued a single-payer plan.

“What I found scared me so badly about the future of the fiscal state of Vermont that I decided I had to tell people,” Wilton, a former state legislator, said.

According to her estimates, Vermont would find itself $2 billion in the hole five years into a single-payer plan.

That dire prediction is based largely on a pair of assumptions — that the $400 million in federal dollars coming to Vermont to support the system would dry up and that the state’s economic growth wouldn’t be as robust as predicted.

But she said given the economic realities both in the state and nationwide, she believed both scenarios could come to pass.

“The revenue sources are a house of cards,” she said. “What happens if we’re not out of the global recession when we implement the system? … We need to think of ourselves as investors. Do you feel good about this process? I know I don’t.”

And even if the economy improves and the federal money continues, Wilton said her calculations show the state only “breaking even” with what it’s spending on health care now.

The doctors who spoke also offered poor prognoses.

Jerry Stein, a retired doctor of obstetrics and gynecology living in Wells, said a large portion of Vermonters and small businesses would lose out under the single-payer system and the exchange.

While a single-payer system could be years away, Stein said the detriments he foresees from it could have an effect far sooner if the legislation for creating the exchange is approved

While the exchange would be a benefit for some individuals due to an income sensitivity system built into it, Stein predicted that small businesses, particularly those that are now part of association health care plans, and the self-insured would suffer.

Stein also doubted a statement made earlier in the meeting by Kimbell, who said that Vermont’s single-payer coverage would be accepted at hospitals and health care providers in other states.

“For Mr. Kimbell to assume Vermont will be entering into contracts with every provider around the country is an interesting notion,” he said. “I don’t know how they’re going to do that.”

Dan McCauliffe, a Rutland dermatologist, listed 10 reasons why he believes access to providers and services would be more difficult under a universal plan.

McCauliffe’s reasons for delays included more people seeking health care services, a departure of doctors who he believes will leave the state, difficulties recruiting new doctors, the possible immigration to Vermont of the medically needy in neighboring states, and global budgets that he predicted will lead to HMO-style rationing of services.

“Cost overruns are going to be borne by hospitals and other health care providers under a global budget,” he said. “The system is going to force me to ration care. That’s not what I went into medicine for.”

The House Health Care Committee last week made two key decisions on the design of a health insurance exchange but deferred a third decision on an “off-exchange” market to this week as committee members continue to seek answers to their unanswered questions about benefit options and prices within the exchange when it becomes operational in 2014.

The committee agreed to limit the exchange to individuals and employers with less than 50 employees on a preliminary vote of 10-0-1 rather than including employers up to 100 employees as allowed by federal law and proposed in H.559. The federal Affordable Care Act requires exchanges to include employers with up to 100 employees in 2016 but allows states to opt for the less than 50 employee standard as a temporary transition period. The committee’s preliminary vote followed a high profile news conference led by Governor Peter Shumlin and backed by House and Senate leadership that endorsed the less than 50 employee small group definition and also called for including a “bronze” plan among the benefit options to be offered on the exchange. Many employers attending a public hearing argued for a lower-cost bronze option to ensure that popular HSA (health savings account) plans will continue to be available to them. The committee endorsed the bronze plans on an 8-2-1 preliminary vote, reversing a decision the committee made last year in Act 48 that called for benefits options of at least a “silver” level or above.

Whether the exchange will be the only source of coverage options for individuals and small employers or whether they will be able to purchase coverage through an “off-exchange” market will be decided this week. Key business groups went before the committee last week to ask why employers should be required to purchase on an unproven exchange and not be allowed to purchase coverage in an off-exchange market. Committee members openly expressed concern that their own questions have not been answered sufficiently and they are finding it hard to give clear responses when pressed for answers from their constituents and local businesses.

The exchange is the linchpin in the governor’s long-term health care reform plan. The administration hopes to use federal funding to design an exchange that consolidates risk pools, standardizes administrative functions, and begins to decouple health benefits from employment. The exchange then could be the foundation to launch the Green Mountain Care universal coverage single-payer plan in 2017.

The House committee is also considering additional amendments to H.559, including the feasibility of requiring employers to offer Section 125 “cafeteria” plans — even if they

don’t offer health benefits — to enable their employees to use pre-tax dollars to purchase benefits as an individual through the exchange. And other provisions in the bill need committee resolution, including a proposal to limit prescription drug out-of-pocket costs.

Meanwhile, a Senate bill that would remove a loophole in the state’s requirement for children to be vaccinated before enrolling in school is under consideration in the Senate Health and Welfare Committee. The bill would preserve an exemption for religious reasons but remove an exemption for “philosophical” reasons. The proposal has sparked a huge response from parents and others opposed to mandatory vaccinations who are peppering lawmakers in both chambers with emails and calls.

Also this week, the Senate Health and Welfare Committee is continuing its review of H.630, the House-passed community mental health reform proposal that includes replacement of the state mental health hospital with regional solutions and a new facility in Central Vermont.

If you are interested in this week’s Legislative Committee Meeting schedules, agendas, and a listing of other meetings and activities, please visit the Vermont Legislature’s website at http://www.leg.state.vt.us/Committee01.cfm Committee meetings are normally updated daily, and are subject to change without notice. If you plan on attending, you may want to call ahead to verify the agenda.

For more information on legislative proposals, visit the Blue Cross and Blue Shield of Vermont website at www.bcbsvt.com or call Leigh Tofferi at (802) 223-6131 or Kathy Parry at (802) 371-3205. If you wish to discontinue receiving these updates or know of anyone else who would like to receive it, please call Kathy Parry or send an e-mail to parryk@bcbsvt.com

Your insurance score is a snapshot of your insurance risk at a particular point in time.  It is a number based on the information in your credit report that shows whether you are more or less likely to have claims in the near future that will result in losses for the insurance company.  The higher your score, the less risk you represent.  The insurance company is also looking for your payment history and your ability to pay your bills on time.  If they have to chase you every month for payment, this costs them money and it will affect your rate.

Insurers use insurance scores along with other risk information, such a motor vehicle records, loss history reports, property inspections and application information to evaluate new and renewal auto and homeowner insurance policies.  It helps them decide “If we accept this applicant or renew this policy, will we likely be exposed to more losses than our collected premiums will allow us to handle?”

Call us today for more information on how your credit score affects your insurance premiums.

Springfield, Vermont Staff

Good food and conversation!

Enjoying the meal.

Last Friday, Finn & Stone held a Christmas luncheon for all employees at the beautiful Reluctant Panther Inn and Restaurant here in Manchester, Vermont. A fire destroyed this property a few years ago and it has been rebuilt and restored to perfection. Visit their website for more information & lovely photos.

We were fortunate that every employee from every office was able to attend. It was a great opportunity for coworkers to meet and visit. We had a delicious meal and a very relaxing afternoon. Chip Ams, President of F&S, spoke to the staff about 2011 being our 50th anniversary and everything we have accomplished this year. To celebrate, we have a new look, a new logo and a new website. We are also now on Facebook and LinkedIn.

We wish our staff, our clients and all our friends a very Merry Christmas, a happy holiday season and a prosperous and healthy new year.

Angela Arbolino & Chip Ams

Angela Arbolino & Jon Ams - Check out Jon's festive Christmas pants! These were the hit of the party.

We are also seeing an increase in fire claims throughout the state. We encourage you to review the property limits for your home and any additional structures you have. While we recognize real estate “market value” has declined for most of us, “actual replacement cost” of structures has not. Contractors are advising that building materials and costs are not declining. “Insurance to value” remains a very important issue.

Our goal is to help you identify risks and exposures and offer a solution before a loss, not after. The choice is yours whether to insure or self insure your risk.

As always, please don’t hesitate to contact us with any questions or to discuss further.

This is a busy time of year for a health insurance professional. Most (though not all) employer plans renew each January. Deductibles are usually calendar year and insurance company rates are filed and approved by the Banking and Insurance Department (BISCHA) on a calendar year basis.

Currently, there are three health insurers marketing to small businesses in the state of Vermont. “Small” is defined in Vermont as having between 1 – 50 full-time, benefit-eligible employees. The three insurers are:

• Blue Cross Blue Shield of Vermont, based in Montpelier and non profit
• MVP Health Care, based in Schenectady NY and also non profit
• Cigna Health Care is offered strictly through the Vermont Chamber of Commerce Association and is a publicly traded international company

The Vermont Chamber of Commerce Association (VACE) has been with Cigna for over a decade and this year the Vermont Chamber sent their business out to bid.  BCBS and MVP offered competitive quotes and BCBS won. So as of January 2012, the Cigna business with the Chamber will be moving to BCBS. The plans will be the same or very similar and the rates will be level. BCBS also guaranteed to cap the renewal increase in 2013 at 10% and hopefully less, depending on claims and the medical loss ratio. I have over 300 accounts with Cigna through VACE and they are thrilled about not having a rate increase in 2012. After receiving 18% last year, this is very good news!

Unfortunately, shortly after this decision, Cigna decided to no longer market in the small group market in Vermont. They are still a competitive option for employers with 51+ employees but they will not be an option if you have less than 50 employees. I think Cigna is a very good health insurance company and am sorry to see them go. They are a progressive and technologically savvy company. We need MORE competition in this state, not less.

If you have any questions or want to discuss your health insurance plan, please contact me at (802) 367-5217.