Vermont Legislature SmartTranscripts:

[Francis McFaun (Vice Chair)]: Good afternoon, this is the Health Healthcare Committee. Our afternoon session, we are going to take up H611, an act relating to miscellaneous provisions affecting the Department of Vermont Health Act. With us, we have several witnesses. First one today would be Addison Schimmelow. I hope I pronounced that name right. You can start off by talking about H611. Thank you.

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Great, thank you very much for having me. Is my audio clear?

[Francis McFaun (Vice Chair)]: Yes.

[Leslie Goldman (Member)]: Great.

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Again, for the record, my name is Addison Stremolo. I'm the Deputy Commissioner at the Department of Vermont Health Access. I'm actually going to hand it over to my colleague Alex to talk through the bill to start off, and then I'm available for questions as well as information about open enrollment, I know had been of interest.

[Leslie Goldman (Member)]: Alex? Thank

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: you, Addy, and thank you, Vice Chair McFaun and members of the committee. I appreciate your flexibility with me today. I have a fever, so I'm not trying to infect all of you with it. I am here today give a brief overview of H-six 11, which is before this committee as the DEVA technical bill for 2026. We have not had a technical bill in a few years, so this is the first one that has come through in my time with the department. So I'm happy to give a kind of item by item overview of what we are proposing, and we can go from there for further discussion. I'm gonna share my screen here. And is that coming through for everyone?

[Leslie Goldman (Member)]: Yep. This is yep.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Okay. Perfect. So for the record, my name is Alex Napraken. I use she, her pronouns, and I'm the director of communications and legislative affairs for the Department of Vermont Health Access. And today we're going to go through a walk through of the technical bill items, including a brief overview of why we're making these changes or why we're proposing these changes and leaving time at the end for questions and discussion. I will also note that many of these pieces, being the nature of a technical bill, are rather scattered. They're a collection of adjustments and corrections from across various statutes that the department feels are advantageous to make at this time. So they cross a lot of different subject matters expertise, subject matter experts expertise. So if there is follow-up questions that the committee would like to dive into, we're happy to return at a later time this week to get more into specific details if Addison or I are unequipped to. So we have six different items and they are each in a section for the technical bill. So section one is the repealing of unnecessary pharmacy reporting requirements. There's a current statute requirement that Diva Pharmacy, the unit within pharma within Diva that handles our pharmacy side, to annually construct two lists of drugs experiencing larger than normal price increases. Pharmacy has indicated historically and continues to indicate that this is an unnecessary administrative burden. These lists are given to the attorney general's office for their drug transparency reporting, and the most recent report concluded that the process of preparing the report itself is too challenging to provide any useful information and that the DIVA information is specifically unhelpful because DIVA is prohibited federally from sharing drug specific net cost information. So we're in alignment with the AGO on that, that this is an unnecessary reporting requirement, and they're not getting what they would like would want from it anyway. So our proposed solution would be to repeal or sunset the statutory requirement for DIVA to provide the information to the AGO or the requirement for the AGO's annual report itself, which is reflected in, the the first option is reflected in the language in front of you in the bill today. Section two is, changes to CURB membership requirements. The CURB is Diva's Clinical Utilization Review Board. It is an advisory body of medical professionals which provides recommendations and clinical insight to the Diva leadership team. Currently, the CURB is looking for ways to increase membership and participation, but it is statutorily set at a 10 member body. There's concern from the curb that this is language that creates a barrier to members serving staggered terms, and amending it will allow more members to participate with a greater opportunity for diverse provider and geographic representation. This proposed solution in the language in front of you in the bill was created and approved by the curb itself. So it is coming to you through Diva and the sponsored bill, the language originates with the body that it is specifically touching. Section three is around increased burial fund limits. The issue here is that certain funds set aside to cover future burial costs can be excluded from Medicaid financial eligibility. DIVA has been approached in the past by interested parties, including the Vermont Funeral Directors Association, about increasing the burial fund exclusion amount, which has not increased since 2002. Very few things in the world have not increased since 2002. The state has authority to update its Medicaid state plan to make this change without legislation. However, the current exclusion amount was put in place in response to a direct legislative action in 2002. So we feel it would be helpful and necessary to have the legislative language changed to correct that. So we would propose increasing the burial funds exclusion for purposes of Medicaid eligibility while incorporating guardrails to ensure the expected use of these funds. And specifically, Diva would increase the $10,000 cap on the prepaid burial arrangements to $15,000 and implement use of a Medicaid payback requirement in the agreement with the funeral home to the extent that funds are not fully utilized. The current $10,000 cap would continue to apply to other burial fund arrangements such as designated savings accounts. This is language that we've worked on internally and also worked with Ledge Council on, and we're happy to continue workshopping that language with Ledge Council as appropriate. We don't talk about burial fund limits often this room or others. Section four, our technical updates. Yes,

[Francis McFaun (Vice Chair)]: of course. We have a question.

[Leslie Goldman (Member)]: I'm sorry, Just looking to see if we have the right because I'm looking at section three and it's about reflective health plan benefits and not burial fund limits. So I'm just curious. I just want to get organized. Looks like a different order. Because here's curve at section four.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Oh, okay. Well, thank you for that. I will make sure that these are in the correct order. Hold on.

[Leslie Goldman (Member)]: Maybe we have a different version? You have an as introduced version. As introduced? That you're working off as introduced?

[Francis McFaun (Vice Chair)]: Alex, are you working on the as introduced version?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: I should have been. I thought I was. Let me make sure that I've got the no, no, no, this is an easy fix. I can do this on the fly. Thank you all for your patience. It's been quite a start to the session as I'm sure you were all feeling as well.

[Francis McFaun (Vice Chair)]: You tell us when you're ready and then you can continue.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: So you're saying that the next thing in the as introduced version is the

[Leslie Goldman (Member)]: Well, I'm saying that section one is prescription drug cost transparency, but I don't think that's what you said as section one.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: That is the is our section section one here.

[Leslie Goldman (Member)]: So that's good. Section two is Medicaid and Exchange Advisory Committee, that's section four, I think, if I'm understanding it right. I'm just trying to get oriented.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Absolutely. That is better than the alternative. Sorry, I'm looking at the bill now. Sorry, said. Section two you said was MEAC, then we can go to that.

[Leslie Goldman (Member)]: Medicaid Exchange Advisory Committee?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Yeah.

[Leslie Goldman (Member)]: Yeah.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Okay. So the technical updates to the Medicaid Exchange Advisory Committee. The federal government promulgated rules CMS two four four two dash f that changes state's obligation around the Medicaid advisory committees. We're basically requesting these changes in order to bring Vermont statute in line with federal changes while preserving our unique structure of a combined Medicaid and exchange advisory committee. This would create alignment between state statues statutes and new federal rules, technical revisions, regarding term limits, committee membership, and the existence of the new beneficiary advisory committee, which launched this year. And I'm sorry, the next section-

[Francis McFaun (Vice Chair)]: Section three. I will let you-

[Leslie Goldman (Member)]: Section three I have is reflective health benefit plans.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: All right, perfect. That's what we have here.

[Leslie Goldman (Member)]: Yay. So,

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Section three, these will all be updated before they are sent to you again. Apologies, members of the committee. Issue being addressed. So the reflective health plans, this is a pretty simple fix. This came through your committee last year, act number two, we couldn't quite get act one, confirmed the, unmerged marketplace, with individual and small group health insurance markets. That was existing statute. We just took out the sunset of it and, codified it in statute going forward. But when we did that, there should have been a technical fix that removed references to reflective plans. Now that the small group market is separate from the individual market, small employers and their employees don't need reflective plans because the small group coverage doesn't offer federal subsidies and the loaded premium issue only affects individual market plans sold on the exchange. So this is a really simple language fix to clarify that reflected plans are for the individual market only. And then next we have curb. If I'm reading my tea leaves correctly, I did go over this previously because I was under the impression Yeah. Of section Section four. So this is where we have the changes to the clinical utilization review board, which I addressed previously. Happy to go into more details on that at any point. Then we

[Leslie Goldman (Member)]: have Alex, I'm sorry. Since she addressed it before, but I was in another page because I thought we were in section two. Can you just quickly repeat?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Of course. I'm happy to.

[Leslie Goldman (Member)]: I would appreciate it.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Of course. So the Clinical Utilization Review Board is an advisory body of medical professionals. They provide recommendations and clinical insight to DIVA. The Curb approached DIVA leadership with this proposal to help increase the participation in the body. Like many of our statewide advisory committees, they're always looking to add new members, that reflect a diverse, geographic and provider representation, but that can be difficult to do, and something they're looking to do is, change the statute slightly to allow greater flexibility in who can participate in the curb and in what timing they can. So these language recommendations were brought to us by the board itself and come to you through this bill as an attempt to help bolster the membership and participation in the CURT.

[Francis McFaun (Vice Chair)]: Any questions from the committee on that?

[Unidentified Committee Member (Male)]: I do have a question, but The two boards, the exchange advisory committee, I think you said that 22 and this one here has got 10 members. Is that the same number we had? This one here says a minimum of 10 members.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Are you asking if the Medicaid Exchange Advisory Committee has the same limit?

[Unidentified Committee Member (Male)]: Yes, if they both have the same numbers as before.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: I don't think that the Medicaid Exchange Advisory Committee member limit is changing or anything around their membership is changing in these proposed language shifts. But the Clinical Utilization Review Board, the CURB, is seeking to amend the statutory requirement of it being a 10 member body. They feel that creates less they they would have greater flexibility to have greater participation if they were able to increase their membership.

[Unidentified Committee Member (Male)]: So that'll be is that 10 all new or is that just expanded a little bit?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: That's the 10 is not a new amount. The 10 is what exists now. So the changes would be to remove the 10 limit so that they can have the number of participants that are willing to be a part of the curve. If there were more than 10, then they could add to their numbers.

[Leslie Goldman (Member)]: Thank you, Alex. So I see that on b, like, line nine, it says a minimum of 10, which is what you're talking about, adding a minimum of. But with that language, it could be a 100. Commit?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: It could be, and I don't think that's the intention. I think the intention is to allow members to serve staggered terms so that folks who are on the way out can overlap with newer members coming in and that that membership could sit more around twelve, thirteen consistently and and not be capped directly at 10. If that's something that the committee is interested in exploring different language options as well, I'm sure we can have that conversation. And I am actually appearing to the curb tomorrow night. So if there is anything that the committee would like to ask or relay about this particular item, I'd be happy to bring it to them.

[Leslie Goldman (Member)]: Well, sometimes it's helpful to have a maximum. I mean, could be 15. It could be whatever. But I'd be curious to know what Curb thinks, if there should be a maximum, and if so, how much?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Absolutely. I can take that to them tomorrow and see what their body thinks.

[Leslie Goldman (Member)]: Thank you. Thank you.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Thank you. Were there any other questions on the previous items we've hit on? And again, apologies for the the circuitous nature of this testimony. Cuteous.

[Francis McFaun (Vice Chair)]: Okay. Thank you. Go up on the next one. Next section.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: I see representative Berbeco has her hand up. Thank online. Oh. That means she's online.

[Daisy Berbeco (Ranking Member)]: No. I don't have any questions. I agree with Leslie that getting any recommended language around maximum numbers for that board would be helpful. But, also, full disclosure, Alex's testimony is in the correct order that it was originally brought to us. And I think that when we were pulling together the draft bill, we decided to change it to align with the order of statutes. So I just wanted to say sorry, Alex. It's my fault. But you've done wonderful.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: This mystery suddenly makes so much sense now. Okay. Thank you. No. That's just a lesson for me to double triple check, but thank you. I appreciate it. So I think we're moving on to our last item on the technical bill spread, which is the request to delay Medicaid coverage of doula services. As this committee well knows, Act 50 of 2025 requires AHS to begin pursuing a state plan amendment for doula coverage by July. DIVA supports the coverage of doulas and the services that they provide, and we recognize the utility and the importance that they serve in our spectrum of care. The department has significant concerns regarding CMS approval for coverage and the potential for increased federal scrutiny throughout this process. It's a hard line for us to walk to approach CMS with requests that we're fairly sure are not going to be approved at this time. We would propose pushing back the date to seek a state plan amendment to July 2028 to create more runway to properly fund and implement this coverage addition. DIVA has also been made aware that OPR is seeking to extend their timeline in conjunction with ours. And I also want to note for this committee some encouraging work that's happening currently with DIVA being engaged with OPR, VDH, and other external stakeholders and advocates, in a doula services working group to keep this process moving forward. We've met twice so far and we're looking to schedule our next meeting later on this legislative session and that has been a valuable touch point I think for us in the department as well as our colleagues around the agency who are engaged in this and other areas of state government to be able to hear directly from the advocates and from providers and make sure that we are moving forward in some fashion that keeps this effort in the right direction without exposing us to undue federal scrutiny or risk. Any questions, committee?

[Leslie Goldman (Member)]: Don't know. Other than me?

[Francis McFaun (Vice Chair)]: I don't. You've got some. You've got some.

[Unidentified Committee Member]: Okay. You? No. Go ahead.

[Leslie Goldman (Member)]: Thank you, Alex. Much appreciated. In section five, which is the burial arrangement thing, does that open this state plan or is that separate?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: I don't believe so. I think Addy would be able to talk to that, but I don't think that touches the state plan.

[Leslie Goldman (Member)]: Okay, thank you.

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Actually, sorry to jump in. We would have to do a conforming state plan amendment on that provision.

[Leslie Goldman (Member)]: So, if I may? So, does that open our entire state plan? Because you were worried a little bit about doula, get it, but how does that is it similar? Or are there similar concerns?

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: I don't want to contradict Alex. Have engaged in this back and forth with the federal government. We have been this year. I think our initial thinking is this one would kind of fly under the radar. But I'm not sure if the exposure that she was referencing would be on the same level as this I

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: can tag onto that to say, I don't want to speak for Medicaid policy, who are really the folks who have the most expertise in this area. But as I understand it, not every Medicaid state plan amendment is made equal. And some of them expose us to greater amounts of risk or greater concern from the federal government than others.

[Unidentified Committee Member (Male)]: We did something, I think, last year with the doulas. They do have to get certified by the state, right? Correct?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: That's going to be a question for OPR on their certification process. They have a whole study around that, and we're working with them to make sure their requirements are in line with what we need to see.

[Unidentified Committee Member (Male)]: We'll save that for them.

[Francis McFaun (Vice Chair)]: What else have they had?

[Unidentified Committee Member]: On the prepaid burial, going from $10,000 to 15,000 is what the consumer pays, correct? Like this is their, they purchased plan and the $10,000 was the limit that we gave them before to make them Medicaid eligible. We're just saying they bought a $15,000 prepaid burial and we're saying that's okay. Right? This is no money out of government pockets at all.

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: No, I mean, it could mean that very marginally more people are eligible for Medicaid, right? Because there's just like a larger range for these burial funds being set aside. But we think that would be kind of de minimis.

[Unidentified Committee Member]: Yeah. I don't see that having an impact at all of the federal government will look at.

[Leslie Goldman (Member)]: Okay. Okay. One more Thank you. I'm sorry, I don't know what preserve monies means. Applicants and recipients to preserve monies. What is preserve monies?

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Is that the language related to the burial funds?

[Leslie Goldman (Member)]: Yes, it's in the first, in A.

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: I think that's just the formulation that says this is an amount of money you can set aside and you don't have to count as a resource as part of your Medicaid eligibility.

[Leslie Goldman (Member)]: Thank you. I appreciate that.

[Francis McFaun (Vice Chair)]: There's been an increase from 10 to 15.

[Leslie Goldman (Member)]: So it doesn't get included in your Medicaid analysis.

[Francis McFaun (Vice Chair)]: Okay. Any other questions? Okay, now you had something else that you wanted to bring up too?

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: I'll pass it over. Sorry, go ahead, Addy.

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Oh, that's fine. Thanks. I understood that we were asked to provide a brief initial update on open enrollment data, which I'm happy to do. And I'll just jump in. I do have some slides to share, but they're very hot off the presses, so I wasn't able to share them ahead of time. So just for context, we're talking about the qualified health plan open and ODIR, open enrollment period, which is part of the qualified health plan marketplace that I think this committee is quite familiar with, but just it's helpful to remember we're talking about a pretty small percentage of our population that gets coverage, healthcare coverage through this mechanism that is operated by DIVA, also known as Vermont Health Connect. So we anticipated a really challenging open enrollment period this year because of a change in federal policy around the tax credits that were available to Vermonters to offset the costs of their qualified health plans. Specifically, the enhanced federal tax credit that was made available under the American Rescue Plan Act several years ago during the pandemic was set to expire at the 2025. So we knew this was going to be a big part of the open enrollment for 2026, is this kind of loss of subsidy and challenges around affordability. So we did a lot of outreach around this and open enrollment opened on November 1, and it just ended last week on January 15. And I think it's been, people have been very eager to kind of find out what has happened with enrollment. And I would just like to say that it takes a while for this all to settle out because there was a lot of activity during open enrollment period, which we actually found really encouraging. I think people heard our message around reviewing their options. Our kind of motto for open enrollment was stay informed and stay covered. And we had very high call volume, a lot of different plan selection happening, and I will share a bit of data around that and then also go over where we are in terms of our overall enrollment. Again, this is initial. We're going to do some more analysis about what this means and also how it continues to progress as we get into the 2026. But we did want to share what we have now. I'm going to attempt to do the screen sharing, which is not my favorite. First, I just wanted to let you know that we're posting a dashboard on our website that has these metrics that I'm going to go over in a way that you can see a bit better than this. But we knew there was interest both in the customer activity and then in the enrollment data, and so we do have this posted at this time and we're doing that on a weekly basis.

[Francis McFaun (Vice Chair)]: Can you explain that shot, those shots a little bit please?

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Yes, I'm going to actually do a one slide per each graph as soon as I figure out how. Here we go. Starting with calls, just wanted to illustrate that our call volume was very high through open enrollment. We actually had one of the highest days in near history in December, recent history in December toward the end of the plan selection deadline for January 1 coverage. It followed a similar pattern to past years, but obviously just more of everything. The second metric is around the plan comparison tool, which is where people go to shop for plans during open enrollment before they make their final plan selection. This shows a similar story, just a high level of engagement and a high level of use of the plan comparison tool. And so this is the big number, which is that our net enrollment, this is as of January 15, is at 30,334 people. That is down and that is as expected because of the affordability challenges that I just described. It's down about 2,400 from our last public report, which was we do quarterly. So it was in September, which is about roughly 6% of the qualified health plan population on the exchange. This slide shows the comparison year over year. And as you can see, it's almost an inverse of last year. Last year, we grew really significantly because of the availability of the subsidies, as well as the silver loading concept that Alex referenced in testimony earlier. So it took a while to see that trend of actually becoming lower enrollment than last year, again, because last year was a pretty unusual year. But now we're well below and on that kind of downward trajectory that we do expect to kind of continue into 2026 as people continue to see their bills and make decisions about whether or not to stay enrolled. Within this net enrollment total, there are two kinds of trends that I think are worth looking at a little more closely. The first is that we had fewer new qualified health plan customers than we did last year. So that's one of the influencing factors for the total net enrollment being down. The second is around disenrollment. And our disenrollment rate conversely was very high compared to past years. And again, you can see those jumps, especially right around December 15, which was that cutoff deadline for January 1 coverage and people making choices to no longer remain enrolled in the qualified health plan. And then we had one more graph on this dashboard, which relates to the metal level selection. So metal levels are the different actuarial values of each qualified health plan that you can choose from. They go from bronze up to platinum, with platinum being the kind of richest plan in terms of what it covers and the smallest amount of out of pocket expenses for enrollees. And this is taking a little bit to kind of shake out as well, because as you can see, gold is still our biggest enrollment area. That's kind of residual from last year when we transferred a lot of people into gold plans because they were getting better value there than the lower metal levels because of our, again, our silver loading policies, which is quite technical. Maybe I can come back to talk more about that if there's interest. But what I wanted to show here is that we are seeing a trend toward people buying into bronze this year because of the affordability challenges with that bronze percentage increasing four or 5% by January 15. So I'm happy to share those with you all. Again, it's posted publicly on our website. Our next step is to look at this attrition that we're seeing kind of by income level and confirm our strong expectation that that is because of the loss of the enhanced subsidies, expecting to see a lot of those people who are over 400% of the federal poverty limit choosing to either buy down into a lower meta level plan or disenroll altogether. And then I didn't say this explicitly, but those subsidies did expire. So we now have a lower percentage of subsidized enrollees. Before in 2025, it was the low 90s. Now it's around 75%. We also saw the average net premium double, which was what we projected would happen with the loss of the subsidies. And then the overall amount of the subsidies coming into our state has decreased significantly with this expiration. It's a really challenging environment, but on policy level, conversations are happening in Washington. We hope to support Vermonters as much as we could through it in terms of maintaining coverage and we'll continue to analyze exactly what that looks like as we get into 2026.

[Francis McFaun (Vice Chair)]: Thank you. Any questions about this?

[Unidentified Committee Member]: So I noticed that the silver level reduced by about 8% and the bronze went up by 4%. First of all, do you have people numbers for those percentages? Maybe you don't yet, but I'm just wondering how many, does that reflect so many people now being completely uninsured or underinsured?

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Sure, yeah, it's a combination of both. I don't have the raw numbers off the top of my head, but I'm happy to get them. Definitely have them. Reduction in silver is really residual from the previous plan year where many, many people moved out of silver and into gold. So that's less reflective of what's going on this open enrollment than what happened kind of after open enrollment last year. But the increase in bronze is definitely reflective of what's going on this year. And that is that concept of kind of buying down and having higher out of pocket costs and potentially being under insured. In terms of the people who disenrolled, who lost coverage altogether, I think there's, we don't know for sure, but in many cases it's probably because they don't have another source of coverage and this was unaffordable to them. That would ultimately impact our uninsured rate, though it's much too soon to tell by how much.

[Leslie Goldman (Member)]: We do a household insurance survey a lot, every two years, every three years. So when do we do again, and when do you think these numbers would be reflected in that?

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: That's a question for you all. I think you kind of commission it, if I'm remembering correctly, that process works. We just did it during 2025, and that showed really significant increases in kind of higher value coverage and people moving into gold plans and maintaining our overall very low uninsured rate. I think in the next year or so, you will see the impact of this change. I think we just don't know because this is such a small portion of the population in the market, how much it will move that overall kind of statewide needle. But yeah, the impact is real happening now and so it would be picked up in any kind of instrument later in 2026.

[Leslie Goldman (Member)]: So you're thinking, if I may.

[Francis McFaun (Vice Chair)]: Go

[Leslie Goldman (Member)]: ahead. In two years would So did it last year, so do it one year from now would be two years, but maybe that's too soon. So I'm wondering, age six eleven a technical bill where that could be included? I'm just wondering where we do that if we wanted to address this.

[Daisy Berbeco (Ranking Member)]: I can help with this, Leslie.

[Unidentified Committee Member]: Great.

[Daisy Berbeco (Ranking Member)]: We usually put it in the budget. And I was gonna ask, actually, if I can jump in or just point out that the household insurance survey wasn't in the budget last time that we actually added it, and it didn't come to us in the governor's budget.

[Leslie Goldman (Member)]: I remember that. So would it be better oh, go. Sorry.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: I'm so sorry. For context, it's usually around every four years. That's the tempo that has been done historically. I think before this year, was 2021. And that is also a kind of joint purview between ourselves and our colleagues at VDH. So I think the actual production of the report lies with VDH and that language is usually included in the budget bill as representative Berbeco said.

[Leslie Goldman (Member)]: Well, that's the standard location for it. Thank you.

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Yeah, just to clarify, Diva doesn't do the survey. We reviewed the results. Obviously, it's a very helpful tool, but it's not in our jurisdiction.

[Leslie Goldman (Member)]: Okay, thank you. Thank you.

[Francis McFaun (Vice Chair)]: Mr. Fisher.

[Daisy Berbeco (Ranking Member)]: I have a question. I don't know if you can see my hand.

[Francis McFaun (Vice Chair)]: I can't. Can you just hold it for a minute, Daisy?

[Karen Lueders (Member)]: I'm Karen Lueders, have a question. Thank you. Addy, I think that Diva estimated the value of the enhanced tax credits in the marketplace study at $65,000,000 Is the outcome of what actually happened, is that something that people could back into how much premium tax credits for vouchers you lost? Is that a reasonable question for you guys to evaluate?

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Yes, thanks for asking it that way. We always include that kind of overall annual aggregate amount in our coverage map that we'll aim to produce hopefully next month. But yeah, it's coming up based on enrollment right now, it's coming out to be a bit higher, around 72,000,000 loss.

[Francis McFaun (Vice Chair)]: Thank you very much. Any other questions? Please. Okay, now, Daisy, go ahead.

[Daisy Berbeco (Ranking Member)]: I have a very important technical question. Where do we find those wonderful charts that you walked us through, Addy?

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Sure. I will provide the link to you all, and they're right on the DIVA website under our reports page.

[Daisy Berbeco (Ranking Member)]: Okay. I've been poking around there. I can't find them, so I'd appreciate the link. Also just kudos to your staff who pulled those together. They're really, really well done.

[Addison Stremolo (Deputy Commissioner, Department of Vermont Health Access)]: Thank you very much. Other questions I from the

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: can send Tasha a link for that, for the committee.

[Francis McFaun (Vice Chair)]: Okay, good. Any other questions from the committee? Okay, thank you very much. Your testimony is much appreciated.

[Alex Napraken (Director of Communications and Legislative Affairs, DVHA)]: Thank you both, always happy to be here. Good afternoon. Thank you.