Health care advocate urges mandatory hearings, clearer public notices for Medicare Supplement rate requests

Michael Fisher, chief health care advocate at Vermont Legal Aid, told the Vermont House Committee on Commerce and Economic Development on Feb. 21 that the state should require hearings and improve public notice when insurers seek large Medicare Supplement (Medigap) rate increases.

Fisher said his office supports the committee’s proposed new threshold — rate requests above 10 percent affecting more than 5,000 covered lives — but urged changing statutory language that currently says the commissioner "may have a hearing" to say the commissioner "shall have a hearing." "I think the bill in front of you says that the commissioner may have a hearing. And we think it it, we think it should say shall have a hearing," Fisher said.

Why it matters: Medicare Supplement plans cover older Vermonters who rely on predictable premiums. Fisher said mandated hearings for large requests would give beneficiaries and consumer advocates a formal opportunity to comment and increase transparency. "There's nothing like shining a light on these things. It's it's important," he said.

What Fisher described: Fisher outlined the advocate office’s role — funded by a single state grant and housed at Vermont Legal Aid — and its involvement in rate reviews before regulators. He said his office hires actuaries to examine insurer filings, intervenes at regulatory proceedings and most often argues that proposed increases are unaffordable for Vermonters.

Fisher and his colleague Charles Becker urged two specific changes to the Department of Financial Regulation (DFR) process as the committee considers updated review rules. First, they recommended the hearing requirement be mandatory for requests that exceed the committee’s proposed threshold (more than 5,000 lives and more than 10 percent). Fisher said he was not insisting hearings be full contested-case proceedings in every instance, but that a hearing should be required and that the commissioner could determine whether a matter rises to a contested case.

Second, they asked DFR to post a simple, easy-to-find public notice on its website whenever a company files for a rate increase, with a short summary (company name and requested percentage) and a direct link to the formal filing in SURF (the System for Electronic Rate and Form filings). "We're not asking... to post all of the documents. But... asking DFR to post, very simply, this company is asking for this rate increase, and here is the, link to the SURF case so that people can easily get to it," Fisher said.

Current process and contrast: Under the existing rules Fisher described, a hearing is triggered only when there is a material difference between actuaries' results — he said the threshold in practice has been a roughly 2 percent actuarial discrepancy. The committee’s draft would replace that actuarial-difference trigger with the size-and-threshold approach Fisher described. Becker noted that the Green Mountain Care Board posts full case documents and public comments in an accessible way and suggested DFR could take a simpler step by posting notices with links to SURF instead of reproducing entire filings.

Intervention and reimbursement: Becker pointed to language in statute (subparagraph 4(c)(4), as discussed) that allows the commissioner to permit an intervener if that entity advances the interests of insured individuals. He recommended keeping that intervention path but struck the portion that would reimburse interveners up to $2,500, saying the intervener provision is useful because it can convert a proceeding into a contested case when appropriate.

Committee response and next steps: Committee members responded positively to Fisher’s presentation and asked staff and agency representatives to review proposed language. Committee staff said Jared Black would review the suggested changes later in the week, and a member asked that the advocate’s drafted language be sent to staffer Jen Carvey and Commissioner Brown for consideration. No formal motion or vote was taken at the Feb. 21 meeting.

Limitations and scope: Fisher noted only a few carriers currently have more than 5,000 covered lives, saying "there's only 3 carriers that have over 5,000 lives," so mandatory hearings under the proposed threshold would be limited in number. He also acknowledged that the committee’s move from a 3 percent trigger discussed in earlier drafts to a 10 percent threshold raises concerns among some members, and he said the changes he proposed were intended to strengthen legislative backstops.

Context: Fisher said his office commonly participates where health care policy decisions are made, including before the Green Mountain Care Board and the Department of Financial Regulation, and that his team fields consumer calls through a helpline. He and Becker framed their recommendations as technical changes aimed at improving transparency and consumer participation rather than expanding regulatory scope.

No formal action or vote was recorded at the hearing; committee staff and the Department of Financial Regulation representatives will review suggested language and follow up with the committee.