Concerns about the well-being of Vermont’s largest health insurer, Blue Cross and Blue Shield of Vermont, may be creating a gap between the state’s insurance regulators and a separate health rate review panel.
Vermont requires insurers to sell all individual and small-group plans through its state-based health insurance exchange, Vermont Health Connect.
Vermont Blue, a nonprofit insurer that covers about 90 percent of Vermont residents who have private health coverage, asked the state to let it increase individual rates an average of 8.6 percent in 2016. The Green Mountain Care Board, the five-member panel in charge of the state’s health rate regulation system, cut the average increase to 5.9 percent.
A competitor, MVP, is supposed to pay $2.7 million to Vermont Blue for 2014 through the Patient Protection and Affordable Care Act (PPACA) risk-adjustment program. The Green Mountain Care Board told Vermont Blue to build the risk-adjustment payment into its 2016 rate structure, and to cut a planned contribution to reserves to 1 percent of revenue, from 2 percent.
One member of the rate review panel, Allan Ramsay, filed a dissenting opinion saying the board should have cut the 2016 increase to 4.7 percent. Hundreds of members of the public told the board coverage is unaffordable, Ramsay said.
Cynthia Stuart, an official at the Vermont of Department of Financial Regulation, had asked the board to let Vermont Blue charge 2016 rates toward the middle of a range of reasonableness, rather than setting rates at the low end of the range.
Always holding premiums at the low end of the range could reduce Vermont Blue’s ratio of surplus cash per enrollee, and weaken its ability to handle unexpected events, Stuart writes in a solvency analysis sent to the board.
Delays built in to the Vermont health insurance rate review process increase the level of risk Vermont Blue faces, Stuart warns.
“It takes up to two years from the time it is evident that a rate adjustment is necessary to the time those adjusted rates are approved and implemented,” Stuart writes.
In May 2013, Susan Donegan, the Vermont insurance commissioner, raised questions about solvency in an order blocking organizers of a new nonprofit, member-owned PPACA CO-OP insurer from selling health coverage in the state.
See also: Vermont CO-OP still in limbo