Rural Vermont's testimony on healthcare!
To the Members of the Green Mountain Care Board,
Rural Vermont has supported, organized, and advocated for farmers, other members of the working lands, and the communities of which they are a part for 34 years. Rural Vermont’s mission is to lead the resurgence of community-scale agriculture through education, advocacy, and organizing in support of Vermonters living in deep connection to one another and to the land that nourishes us all.
Locally and nationally farmers and members of our rural communities are identifying healthcare as a significant issue affecting their farms, livelihoods, and communities; and are asking farming organizations to represent them in the policy making process. In the HirednAg 2017 National Farmer and Rancher Survey, 72% of respondents wanted the USDA to represent them in national health insurance policy discussions. In Rural Vermont’s 2018 Issues Survey - in which we identified a number of policy and / or organizing opportunities which we could focus on, and asked respondents to prioritize them - Healthcare ranked highest in over 200 responses. It is our intention to honor these voices - and to work alongside others to organize agricultural, food systems, and rural economic development organizations (among others) to understand healthcare as an integral issue for their members, to advocate for their communities, and to help to bring them and their voices to conversations about the future of healthcare in Vermont, the greater northeast, and nationally.
Rural Vermont feels there is sufficient evidence to support the position - our position - that the proposed rate hikes submitted by Blue Cross Blue Shield and MVP, and ongoing significant rate hikes on a yearly basis, are unaffordable, excessive, and inequitable.
The following are some of the HirednAg 2017 National Farmer and Rancher Survey Findings:
Health Insurance is a National Farm Policy Issue - Health insurance is tied to farm and ranch risk management, farm viability and economic development.
Over half of the households (55%) are not at all or slightly confident that they could pay for the costs of a major illness or injury without going into debt.
22% of the farm households had a medical or dental debt of over $1,000.
Over three-fourths (79%) of these households said health insurance was a risk management tool.
Almost half of farmers and ranchers (45%) are concerned they will have to sell some or all of their farm or ranch assets to address health related costs such as long-term care, nursing home, or in-home health assistance.
Just over half of farmers and ranchers (52%) are not confident they could pay the costs of a major illness such as a heart attack, cancer or loss of limb without going into debt.
Farmers are particularly vulnerable to healthcare needs (avg. age of app. 58 years, type of work, etc.)
The USDA forecasted avg. national net income for farmers is projected to be -$1,449.00 for 2019. This will be an improvement from 2018.
The Vermont Farm to Plate Annual Report from 2015 presents the following data with respect to farm based income:
79% of farms under 220 acres—4,491 farms— got <25% of household income from farming.
67% of farms over 260 acres—893 farms (the number is reduced substantially at this point) —got >25% of household income from farming.
What we’d like to point out about this information is the low bar set at 25% of household income for farms of both scales, as well as the great number and percentage of farms in both categories which make less than 25% of their household income from farming. This further attests to the economic challenges faced by farms, farm families, and farming communities.
Dairy farmers have been one of the most economically devastated sectors of farmers over the last few years - and over the last number of decades. According to data provided by the Vermont Agency of Agriculture, the number of cow dairy farms in Vermont has dropped from 1,015 in 2010, to 728 in 2018. From January to July 2019 the number has dropped from 700 to 675. In the last couple of months we have seen conventional milk prices rise for the first time in approximately 5 years - yet they are still below the cost of actually producing the milk on most farms. The Organic milk market has remained closed to new producers for well over a year, has asked many producers to produce less milk, and has in many cases also reduced its payments to farmers. Damien Boomhower, a farmer milking an app. 60 cow Organic dairy herd in Franklin County told me in November 2018 that he is losing more than $1,000 / cow this year and is not sure if he wants his children to take over the farm or become farmers. The past few years have seen milk processors sending out suicide prevention notices with paychecks to farmers - and a substantial number of dairy farmers taking their own lives nationally, including in Vermont.
Rural Vermont strongly believes that general trends in farm income, farm viability, and rural economic health need to be justly considered in your deliberations concerning these proposed rate hikes and their affordability, and how access to - and quality of - healthcare in VT is affected by the high costs of premiums, deductibles, and copays.
Given that health insurance costs affect farm viability and the choices farmers make (as established in the testimony of farmers which Rural Vermont has heard, as well as the surveys and data provided in this testimony), here are just a few of the potential impacts of raising rates:
Environmental impacts: the Farm and Water Coalition - as well as many organizations locally and nationally - have identified a nexus between farm viability and water quality (among other environmental outcomes). Farms which have a stable income and profit are able to invest in methods of agriculture which provide more protection of - if not generation of - ecological integrity (which also affects human health).
Compromising Farm viability (as attested to above)
Worse health care outcomes for individuals, families, communities (including mental health). Testimony the GMCB has heard suggests that people already choose not to visit healthcare providers or take necessary medications with the current cost of their healthcare. This will only increase with further rate hikes - leading to unnecessary worse health outcomes.
Diminished rural community vitality and economic viability: less time available for volunteerism, poor small business viability, etc.
It is inequitable and unjust for many sectors of the economy (in this case, farmers and many local small rural businesses), of society, to be told by regulators, industry, and policymakers that they can not be afforded the cost of doing business, or of providing necessary healthcare to themselves and their families (as with many people who live in Vermont) - while allowing another sector assurance of its profits in the form of rate hikes well above inflation rates and at the expense of the general public.
This proposed rate hike will without a doubt affect the affordability of, and access to healthcare for many Vermonters who are currently struggling to even afford the costs of their current healthcare.
At the Blue Cross Blue Shield hearing, a representative of BCBS stated: we are “on our way to a more sustainable healthcare system” through this process. This is certainly not true for a public which is currently being asked to afford some of the most expensive healthcare with some of the poorest healthcare outcomes in a “developed” nation globally. And though it is not the purview of this particular hearing, Rural Vermont feels that a publicly funded universal health care system is the only sustainable path forward, and the only path which assures the affordability of, and access to, healthcare for everybody.
This same representative said that “solvency [for his industry and company] is the most fundamental factor in consumer protection”. He said - to paraphrase - that individual Vermonters may struggle to afford healthcare - but better to struggle than to lose access. These statements, and those in the previous paragraph, belie the disregard of BCBS for the testimony which people - its members - provide year after year to this Board in relationship to its proposed rate hikes, their access to care, the affordability of care, and the quality of the care they receive. Rural Vermont understands that people do lose access to healthcare when healthcare is not affordable.
He also said that healthcare is as expensive as it is because BCBS must provide rates based on a “community” vs. individual basis in VT. We know that our community members are struggling to afford their premiums, deductibles, and insurance regardless of age or whether they are on medicare.
He said that because there is “no penalty” for not carrying healthcare in VT - BCBS will lose clients. BCBS and MVP may lose clients, however it is because they offer unaffordable and inadequate coverage, and many people have experienced poor quality of care. Many of the fees suggested over time for not purchasing healthcare have been less expensive than the excessive costs of healthcare itself.
As Blue Cross Blue Shield has pointed out - there are many rising costs in the healthcare industry from pharmaceuticals to hospital executive salaries which affect their rate projections. We recognize these factors and agree that they are problematic and must absolutely be addressed - and we feel it is unjust and inequitable to pass along the cost of these problems to the rate paying public when most of this industry and its players enjoy profits and salaries well above most Vermonters.
Lastly, we recommend that this Board suspend the end date of this public comment period - and conduct public hearings like this across the regions of Vermont outside of normal work hours. This hearing and process itself is relatively inaccessible to those who need to work regular work hours, or travel in order to have their voices heard in person.
Rural Vermont Field Organizer