Vermont's inaction on health care reform

by Don Turner

26,000, $500, and 2.

26,000 represents the number of Vermonters who remain uninsured—most of whom find health care coverage here unaffordable.

$500 represents the approximate premium a 40-year-old Vermonter will pay per month to afford the cheapest health care plan on the market.

And 2 represents the number of major health insurance companies left in Vermont—Blue Cross Blue Shield and MVP.

All three numbers add up to a failure on the part of policymakers to deal with our health care crisis. For years, politicians in Montpelier have talked about addressing health care reform. The problem is that they’ve focused all of their efforts on coverage provisions, with virtually no attention paid to affordability and innovation.

That’s one reason why Vermont is one of the most unaffordable places for health insurance in the entire nation. And it’s moving in the wrong direction.

Consider this: in 2019, the average benchmark silver premium for a Vermonter was $505 per month, compared to $475 in New Hampshire. But in 2021, Vermont’s average premiums have skyrocketed to $669 per month—a 32 percent hike, while New Hampshire’s average premiums have plummeted to $357—a 25 percent drop over the same period. It’s no surprise Vermont has higher health insurance premiums than all but three other states.

Our failure to consider innovative methods of delivering affordable health care—coupled with our unwillingness to break down government barriers—has directly contributed to this problem.

Ask yourself this: this past legislative session, did you hear the Vermont Legislative Majority talking about ways to lower health care costs? Expand options? Open up new opportunities? Or even make permanent some of the waivers of regulations that were adopted as part of our COVID-19 response?

The answer is a clear no. The Majority in Montpelier has no desire to engage with real health care reform.

To present an example, here are just a handful of some of the restrictions and failures of Vermont policymakers when it comes to health care:

Vermont unnecessarily restricts the ability of businesses to band together to offer affordable health plans off of the ACA exchange, effectively undermining employer-based coverage. Similarly, Vermont prohibits lost-cost, short-termhealth plans, which cost as little as $150 per month in New Hampshire. Vermont also doesn’t allow flexibility with Direct Primary Care (DPC)arrangements, where individuals and providers can work out an arrangement together outside of the insurance companies.

At the same time, Vermont is one of only two states to prohibit age-rating, meaning insurers aren’t allowed to take age into account when setting rates. As a result, young Vermonters in the 25 to 34 age bracket can’t afford health care and have an uninsured rate that’s triple the statewide average. And, despite the majority of northeastern states implementing a reinsurance program (which lowers premiums by drawing down federal dollars to offset expensive medical claims), Vermont has yet to act on this no-brainer.

Meanwhile, instead of allowing medical providers to practice across state lines via expanded telehealth, Vermont set up a working group to “look into” the issue—which is effectively kicking the can down the road, even though we have a provider shortage today. Vermont also has among the most stringent Certificate of Need (CON) laws in the nation—these are regulatory burdens that protect vested health care interests by requiring new medical providers to get special permission from the Green Mountain Care Board before opening, expanding, or even upgrading new medical equipment. Independent estimatessuggest we could save $228 annually for every man, woman, and child in Vermont by eliminating our CON laws. That adds up to millions in savings each year.

Speaking of the Green Mountain Care Board, this is a $9.1 million board that meets to over-regulate health care providers in Vermont. The total annual salaries of the 5 board members are nearly $600,000 collectively. Do we really need to be paying 5 bureaucrats more than half a million dollars per year so they can rubber-stamp double-digit rate increases for insurance companies?

Again, this is just a sample of some ideas that could be taken to lower health care costs. Other great ideas are out there too. Maine, for instance, created a “Right to Shop” program where consumers are given complete price transparency in purchasing health care services, and get to share in the savings if they use high-quality, low-cost providers—even if they’re out of network.

Vermont lawmakers need to get serious about actually lowering health care costs instead of continuing down the track laid by the failed policies of the past. It’s long past time to try a different approach.

This commentary is by Don Turner, a former state representative from Milton, former House minority leader, current Milton town manager and longtime member of the Milton Fire and Rescue departments. He was a candidate for lieutenant governor in 2018.