Kevin Mullin: A challenging summer for health care, with hope on the horizon 

This commentary is by Kevin Mullin, who will retire Aug. 4 after five years as chair of the Green Mountain Care Board. Earlier, he served 19 years as a state representative and state senator.

As I prepare for retirement and the Green Mountain Care Board enters its busy summer regulatory season, the implications for Vermonters weigh on me heavily. 

The last two years have been incredibly challenging. The pandemic has put unprecedented strain on Vermonters and families as well as our health care facilities and their workforce. This summer, as the board reviews health insurance premium increases and hospital budgets for 2023, the country is facing inflationary pressures with far-reaching impacts for everyone. 

I know that the choices before the board are going to be the hardest yet. Our fragile health care system needs stability today and sustainability for the future. 

The board’s review of health insurance rates determines how much Vermonters covered by individual or small business health plans pay each month for their insurance coverage. In making these decisions, we are charged with considering “whether a rate is affordable, promotes quality care and access to health care, protects insurer solvency, and is not unjust, unfair, inequitable, misleading, or contrary to Vermont law.” 

In other words, we are tasked with balancing affordability and access for consumers with making sure insurance companies collect enough money to cover the cost of care for their members and maintain required reserves. Difficult times such as these only heighten the tensions that are inherent in these factors. 

I know that premium increases will further strain families and businesses already facing hard times. As a former small business owner myself, I’m seeing employers in my own community struggle with staffing shortages, supply chain issues, and rising prices for materials. Hospitals, which make up about half of Vermont’s health care costs, are facing these pressures acutely — a trend that is being seen around the country. These increased costs are passed along to consumers through the insurance premiums they pay. 

I also worry about gridlock in Washington and losing much-needed federal support for consumers. During the pandemic, the federal government provided relief through special insurance premium subsidies for individuals who bought health insurance through Vermont Health Connect.

Unfortunately, as Chief Health Care Advocate Mike Fisher recently wrote, this federal support is set to expire at the end of this year. The loss of these subsidies will make rising premiums sting even more. 

Following years of work to contain hospital costs and improve affordability, Vermont’s hospitals are facing profound financial strain, putting us at risk of losing key services around the state and endangering access for patients. On the other hand, as Vermonters struggle during these tough economic times, high prices are also a barrier to accessing health care. 

All of these factors mean that this is going to be a year of really hard decisions, with even harder impacts. I am keenly aware that any decision the board makes will have far-reaching implications for Vermont families, small businesses, and our health care system. I will be leaving knowing that the board members will reach the best possible decisions, given the choices before them.

In this challenging environment, we have to do the best we can with what we have and balance our priorities, as required by Vermont law. The challenges this year underscore the need for Vermont to envision a sustainable health care system for years to come. 

The silver lining is that weathering hard times goes hand in hand with innovation. For years, the board has been talking about hospital sustainability in our annual hospital budget review process, and we are not the only ones. The Legislature recently passed Act 167, tasking the board and other government agencies with engaging communities and providers to envision a more sustainable health care system. We are lucky to have committed partners in state government and the private sector as we embark on our piece of this complex work. 

Looking to the future, I feel a sense of hope. As I see it, our goals are to put the focus on sustainability, address the tension between access and affordability, and continue finding ways to make sure all Vermonters can receive the right care at the right place at the right time. 

It is not just about how much we spend on health care. It is about health outcomes and what we get for each dollar spent. This is not going to be easy, but nothing this important ever is. 

How Vermonters can get involved 

A key pillar of the board’s work is to make health care more transparent for Vermonters. Our meetings are held in public, and members of the public are always encouraged to attend and submit written public comment. 

Upcoming opportunities to engage with the board include: 

Rate reviews

BlueCross BlueShield of Vermont hearings, Monday, July 18, and tentatively Tuesday, July 19, beginning at 8 a.m. 

MVP hearings, Wednesday, July 20, and tentatively Thursday, July 21, beginning at 8 am

Rate review public comment forum, Thursday, July 21, from 4 to 6 p.m. 

Hospital budget hearings

Weeks of Aug. 15 and Aug. 22, all-day hearings on Mondays, Wednesdays and Fridays beginning at 8:30 a.m.