Vermont Legislature SmartTranscripts:

[Alyssa Black (Chair)]: Hi, welcome back. So we're moving from S-one 190 to sections four and ten, which have to do with public employees and public employee health insurance and studies and things. So Sue, do want to come up and join us? And I am sorry, Siglowski. Yes, you got it right. Thank you so much for having me in this morning.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: This is my first time ever testifying in I this think so. So my name is Stacy Glowsky. I am the executive director for the Vermont School Boards Association. And before I start discussing the bill, I thought it would be helpful to take a moment to provide information on the governance of Vermont Education Health Initiative, which is VIHI, because VIHI is affected by S-one 190 secondtions four and ten.

[Alyssa Black (Chair)]: Yeah, thank you so much for doing that.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: So VIHI is a nonprofit organization. It provides health benefit plans to public school employees throughout the state. VIHI is a self insured inter municipal health pool responsible for the design and rating of the health plan. When setting premium rates, VIHI takes into account expected claims, expenses, administrative costs, and maintaining adequate reserves for the time that claims exceed premiums. The organization is governed by a six person board of directors. Yes, the high is governed by a six person board of directors with three board members appointed by the Vermont School Boards Association and three board members appointed by the Vermont NEA. Due to the split nature of its board of directors, VIHI does not have an official position on S-one 190. I am here today to provide you with the VSBA's perspective on the bill, given that the SBA appoints half of the BI Board of Directors. My testimony, as you mentioned, is focused on sections four and ten of the bill. In addition to this written testimony, have attached our suggested changes to the language in sections four and ten as markup to S-one 190 as passed by the Senate, and that is posted on your webpage under today's kit. Before covering sections four and ten specifically, I would like to express agreement with the comments of the Department of Financial Regulation Commissioner that the benefits of reference based pricing for the qualified health plans should be spread across all commercially insured groups. With that approach, we believe that it's possible Section 10 of the bill could be removed entirely as all groups would already be receiving the savings. I will now move on to Section four of the bill. Section four of S-one 190 requires the Green Mountain Care Board to determine the opportunities available through implementing reference based pricing for the state employees' health benefit plan and the health benefit plans offered by BIHI. The current language of the bill requires BIHI along with the Green Mountain Care Board, the Department of Financial Regulation and the Department of Human Resources to analyze claims for inpatient and outpatient hospital items provided and services delivered to determine the opportunities available and the projected impact on Vermont's hospitals. This requirement goes beyond the role of a nonprofit organization and places a significant financial burden on VIHI, which is not covered in its fiscal year twenty twenty seven budget. Therefore, we request that VIHI be removed from the responsibility of conducting the analysis and that its role in the process is limited to providing the Green Mountain Care Board with access to and an explanation of the claims data necessary to perform the analysis. So those are our comments on section four.

[Alyssa Black (Chair)]: The commissioner of DFR was in here the other day or yesterday when we did this, and he indicated that this section essentially was not necessary at all. He said, we already have this data, and he literally picked up a piece of paper and said, it's right here. Do you think that this is necessary?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: We do not think it is necessary. Are suggesting that if you do leave it in the bill. We would out of it. Yeah, we would take it out of the bill. But if you leave it in the bill, we have some suggested language changes.

[Alyssa Black (Chair)]: All right.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: Same thing really for Section 10. Section 10 of S-one 190 creates the Public Employee Health Benefit Authority Study Committee. The duties of the Study Committee are expansive and it is expected to fulfill those duties within a short timeframe.

[Alyssa Black (Chair)]: The

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: The treasurer's office noted that it did not request this addition to the bill that the timeframe is very short and that the proposed appropriation is insufficient. And, I would also note that the Senate Health and Welfare Committee added Section 10 without asking for taking any testimony from BIHI or, from the Vermont School Boards Association. If this committee decides to retain section 10, we strongly recommend revisions to the membership of the study committee, changing it from various unions and employers, which is what is on there now in this bill, who would be eventual participants to the state level decision makers who have the financial expertise in insurance to perform a meaningful analysis that focuses on capturing the costs and benefits to the state and to taxpayers. Our additional recommendations regarding the study committee are set out in the attached markup to S-one 190 as passed by the Senate. And they have to do with the report that would be issued by the study committee and the duties of the study committee and the timeline.

[Alyssa Black (Chair)]: May I ask you, and you may not know the answer to this, the treasurer did not request this. I yet to hear anybody who did request this. Do you know where this came from?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: I do not know where it came from.

[Alyssa Black (Chair)]: Is it is it the Is it the opinion of Vijai that you're not supporting it because you don't know where it came from or because you don't support the premise of the questions being asked? I can't give you

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: the opinion of VHI. I can give you the opinion of the Vermont School Board Association. And it's not because we don't know where it came from. It is because we think that the makeup of the study committee, as I mentioned, is not the right people to be conducting the analysis. We also think that some of the language in S-one 190 secondtion 10 sort of presumes that this is going to happen and asks the study committee to have a blueprint for how it's going to happen. And it focuses more on that than on should this happen at all and analyzing the situation.

[Alyssa Black (Chair)]: So from the perspective of the Vermont School Board Association, from what I'm gathering in all this language is that it's envisioning a day where all publicly funded employees would be combined into one health insurance. From the opinion of the Vermont School Board Association, is that something they would be in favor of or is that something they would not be in favor of?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: I think that's a difficult question to answer right now. This study committee would need to do That's the reason this study committee exists is to do that analysis. I

[Alyssa Black (Chair)]: think, though, it's a question that has been asked and contemplated for many years. Has it been discussed or there's been no discussion in the school board association? Like, hey, people are floating this idea. What do we think about it?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: I think we've been more focused on the current situation and how it's impacting school budgets and process for statewide bargaining for school employees' health benefits.

[Karen Lueders (Member)]: Is that why you believe it came up? It's that? You said it's been for a while, and is it because we're now doing this school consolidation that we're leopards in this study?

[Alyssa Black (Chair)]: I have no idea where this came am basically trying

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: to be cagey or anything.

[Alyssa Black (Chair)]: I have no idea where it came from. However, I think it would be, I think everybody would agree that for the past several years, there's been talk about, Hey, shouldn't we I think there's a bill on the wall in House General, possibly, that sort of contemplates this same sort of thing. I guess I was just I think it may be trying to get to that, possibly.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: The little on the wall in House General that I'm aware of has to do with the statewide bargaining process. Which

[Alyssa Black (Chair)]: would just be BIHI, correct? Yeah. I mean, I think I just mean, in general, there's been a lot of talk about over the years, should things be combined? Should we redo VIHI, the collective bargaining process, all of that? I guess I was just wondering if you had an opinion on any of those previous discussions.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: The treasurer's office highlighted it well that this would take a significant amount of analysis and that that would be quite expensive.

[Karen Lueders (Member)]: The study itself would be very expensive?

[Alyssa Black (Chair)]: I think there's an appropriation that makes a version of 300

[Karen Lueders (Member)]: and

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: $3.50? No, Jen Carpenter, that's just a So there was gonna be a $50,000 appropriation in that. Oh, 50? Yeah, so now that came up. And I think, I'm not sure that was, I'm not sure what the rationale for the specific number was, but the

[Karen Lueders (Member)]: preparations committee took that provision out and said something along the lines of the extent funds are appropriated. Okay.

[Alyssa Black (Chair)]: Courtney, did you have a I was just going to Courtney, was just say what Jen got to, which is it did get changed to if funds are Okay. So the Senate's opinion that we keep it in there just in case funds become available.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: Leslie appropriations. Yes. I think your question

[Lori Houghton (Member)]: is really important is like going upstream with the section. This section is like, well, what's the problem? And yes, it may be expensive to have a study, but does it end up saving more in the end? I'm just trying to understand that you know obviously more history than I do, because from you said it's been years. I didn't even know that. So I'm just a little wondering how we answer that question. What is the problem that these two sections are trying to solve? And is this how we want to solve it? In B, it does involve a big Mountain Care Board. I don't know if we want to hear testimony from them or not. I'm just a little confused about the, like you said, the problem that we're trying to I mean, I think I understand the problem in a larger sense. Yes, it might be better to commingle all these public groups and it'll be cheaper in ten years or whatever. Is that worth doing now?

[Alyssa Black (Chair)]: I guess I like your question of what problem are we trying to solve. Do we think that the system that we have currently is not working? I guess that would be a question for you.

[Lori Houghton (Member)]: Yes. I

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: could provide you with the handouts that I have about the cost of healthcare benefits and how they impact the cost of education. And I can send PDF for posting to your website. But just to provide you with some of the information from here, health care benefits for public school employees are approaching $400,000,000 annually. They're one of the fastest growing drivers of education spending and property taxes. FY '25, the increase was 16%, '26 was 12% and FY '27, 7.3%. And the share of school budgets that these costs are taking up is increasing. So in 2018, it was 10% of school budgets. Now we're at 15% and if the trend keeps progressing, we'll be at 20% very soon. So imagine that one fifth of school budgets are just for the health care costs. That's what we're heading toward. So yes, I think we do think that there is a problem. What

[Lori Houghton (Member)]: does this do to help? Oh, I thought you were passing those around.

[Alyssa Black (Chair)]: Oh, yeah. Would be great. Lori, did you Sorry

[Lori Houghton (Member)]: to interrupt. I'm good.

[Alyssa Black (Chair)]: Has the educators health benefits been increasing at a rate at a different rate than health insurance premiums across the board for other health insurance? I mean, Blue Cross Blue Shield administers. I'm wondering if the educator's health insurance is increasing at higher rates than the other books of business that Blue Cross Blue Shield has. I guess that's what I'm asking.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: Yeah, think that would be a great question for Blue Cross Blue Shield. I can provide you with some information about the actuarial values of plan. So most of the participants are on the Vijai Family Gold CDHP plan. Just to give you an example of how the cost has increased in FY '18, a family plan annually would it be what it was 17,394 and FY '27 we're looking at 43,920. And that plan when you factor in the HRA the actuarial values are in the 96 to 98% range.

[Karen Lueders (Member)]: So an actuarial value? Never mind.

[Lori Houghton (Member)]: So like if you lower an

[Karen Lueders (Member)]: actual value than your premiums for that,

[Lori Houghton (Member)]: Is there a correlation there? Yes.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: What they have is a high deductible plan, but the deductible is completely covered by the HRA. So there is no deductible that needs to be paid. Lori? I really like the language that you have added under 1B. And I think we'd start getting to the question of why is this increasing so much and how can we help find a path forward? But I would still love to know how this whole section got

[Alyssa Black (Chair)]: in here. Yeah. Your, you you talked with 96 actuarial value. To 98, yes. You know, oftentimes a high deductible plan is less expensive and kind of the concept of when the member has skin in the game, they're less likely. You just said, though, that their HRAs are fully funded. Do you think that if they had skin in the game, that perhaps costs would go down? Yes. Okay.

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: And that's what the statewide bargaining process, know, that there's two sides bargaining. The employer commissioners are appointed by the Vermont School Boards Association and they have, you know, argued within that process for a little bit of skin in the game, but the final, it's always gone to arbitration both times that this process has got has happened. And the arbitrator both times has picked the last best offer of the employees, which did not include that. The arbitration process, can you speak a little bit? We haven't really delved into that in this committee. I know that there is a particular arbitration process

[Alyssa Black (Chair)]: for this? Yes. Can you speak a little bit

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: to that? Yes, sure. So the process begins in April with the parties. Well, I should back up. The process really begins in the fall before the bargaining starts when the School Boards Association and the Vermont NEA send a letter to superintendents with a collection tool and huge amounts of data are collected in order to inform this process. And then we both have consultants that look at the data and agree on baseline numbers. And then the process begins in April. It will actually begin next April, April 2027. And it goes through the summer with various stages, including mediation and a fact finders report. And if the parties have not reached an agreement, then in the fall, they go to arbitration and the arbitrator is required to pick one side or the other side's last best offer in its entirety.

[Alyssa Black (Chair)]: And this doesn't happen yearly?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: No. Depends on how long the agreement or the imposed arbitration decision is for. But normally it's usually two to three years is the time period. So the next opportunity for different results would be for plan year 2028. It would actually be plan year 2029.

[Alyssa Black (Chair)]: Can you remind me, does the educators health insurance, is it their plan year roll July to July or are

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: they January through December? January through December. So

[Alyssa Black (Chair)]: they would be bargaining in 2027 throughout the summer, not for plan design for 2028, but rather the plan design for 2029. Correct. Okay. Thank you. That's I appreciate it. Any other questions? Yeah. Go ahead, take your questions. So this doesn't include retirement?

[Lori Houghton (Member)]: Correct. Right.

[Alyssa Black (Chair)]: Do you have an estimate on how much that costs?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: I do not have that information.

[Alyssa Black (Chair)]: Do you have any information, because retirees the year before had Blue Cross a Medicare Advantage, correct? And with Blue Cross finding down there, what do they have now?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: I don't have the specifics on that. I know there was a change that the treasurer's department would be able to give you the information.

[Alyssa Black (Chair)]: I think it's Spring Battle.

[Karen Lueders (Member)]: It is? Health Spring.

[Alyssa Black (Chair)]: Something like that. Something spring.

[Lori Houghton (Member)]: Health. Okay, so it's

[Alyssa Black (Chair)]: still an advanced plan, they didn't put them back into traditional Medicare? Okay.

[Lori Houghton (Member)]: The retired people? Yeah. Oh, I know people who were forced off Medicare. Maybe I didn't understand what they were saying.

[Alyssa Black (Chair)]: Thank you. Thank you. Thank you for your language suggestions, really appreciate that.

[Karen Lueders (Member)]: I did have one.

[Alyssa Black (Chair)]: Oh, I'm

[Karen Lueders (Member)]: sorry. It has to do with what I've heard from some board folks about a lot of folks and families joining on this plan because it's so good. And so do you have any sense of what increase per year is attributable to folks being added to these plans? Do you have any delineation of that?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: Move to a family plan, you mean? Yeah, family plan. No, I don't have that

[Lori Houghton (Member)]: A shift

[Karen Lueders (Member)]: for things to be add on to these because wherever they were getting their health insurance before, other employers are not as good or not getting it anymore. Yes. Therefore, let's stop this. And there's an increased cost driver there. Do you know what that is?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: I don't know. I don't have a specific number for you.

[Karen Lueders (Member)]: Would there be a way to

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: find that out? I could certainly ask. I'll try to find it out. Yeah. I think that would be something that you'd need to gather data from every district, probably. Yep.

[Lori Houghton (Member)]: But they probably have it. They may. Thank you.

[Alyssa Black (Chair)]: What is the cost share currently as far as employer to employee?

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: For the premium? Premiums. It's eightytwenty. Eightytwenty. Yes.

[Alyssa Black (Chair)]: Great. Thank you. Hi,

[Karen Lueders (Member)]: Colin.

[Alyssa Black (Chair)]: Debra. You're the other side of the bargaining table.

[Colin Robinson (Vermont-NEA)]: Not me personally, but the members I represent. Yes. Yeah. Yeah. So good morning. For the record, Colin Robinson, Vermaun and Yen. Good to be here again. I am hearing the questions before and on Tuesday, I feel like I'm about to reveal a big mystery. So hopefully that will be helpful as you consider S-one hundred ninety. So first of all, Vermont DNA is a union that represents about 13,000 public school workers, teachers, bus drivers, school support staff across the state, organizationally been involved in broad systemic healthcare reform efforts for thirty plus years around the advocacy, the creation of Caledonia Healthcare, Green Mountain Care, Doctor. Dinosaur two point zero, recognizing that Vermonters' ability to access high quality affordable healthcare is an impediment to all the things our members interact with, with their students and families every single day. And of course, the ability of Vermonters, including our members, ability to meet their basic needs and afford the healthcare. I also want to acknowledge the work that this committee did last year on Act 55. Just in the VHI pool, that saved $15,000,000 just that one act. 15 or 15? 15, one-five. Yeah, just that one act, 15,000,000 combined with the GMC B budget orders, that was another $10,000,000 So that's $25,000,000 of savings realized to school boards, taxpayers and our members, because as Sue just mentioned, our members pay 20% of their premium, school districts pay 80%, bigger number of 80% is bigger, 20%, a bigger number is bigger as well. Getting down to s one ninety, Romanian EA has been a longtime advocate for reference based pricing. We've been engaged in conversations with the auditor's office, the Green Mountain Care Board, and many of you and your predecessors for over six years on the value starting in Montana was the model there. And that was one of the reasons why back in 2024, we worked with Senator Kitchlow and Senator Lyons to get into the fiscal twenty five budget, a study of reference based pricing for the two big public sector pools, the Vermont State Employees Pool, as well as Beehive, as you've heard about before. Green Mountain Care Board completed that study in December 24, and I'll share that study with the committee afterwards. But the last full year that they had data was 2022, and it showed combined between the two pools at a reference based pricing Medicare benchmark of 200%, in that single year would have saved $79,000,000. Across the five and a half years of study, was over $400,000,000. And just in the VHI pool alone in 2022 would have been $48,000,000, or $230,000,000 over the full five and a half years. Obviously, that's 2022, so we know those numbers would be bigger. So for several years, both Ronin E and VSEA have been advocating for taxpayer purposes, for all the reasons for making this conversation, potentially for our pools to be a pilot. So that's why we were excited when S-one hundred ninety looked at the QHP as a potential pilot. We said, well, okay, we recognize that there's a healthcare affordability challenge here, reference based pricing is the path we're on as a state, Great. We're on board. We'd be happy to go there right now for everybody. That makes a ton of sense. And if the decision and the desire is to move forward with QHP, let's think about also looking to realize significant gains, knowable gains because of this study for property taxpayers, for the general fund and for our members. So when S-one 190 was being considered in Senate health and welfare, we brought this to them. At that point, there wasn't an interest in going beyond the QHP, so you have the study language in front of you. The study language is essentially intended to be a refresh of the December 2024 study that GMCV did, and it came as a result of our request to say, okay, if you're doing QHP, let's also use and recognize that we have some analysis specific to these two pools that can have real material savings for taxpayers right now. We support the study. That being said, our preference would be to move forward on RBP for everybody on a timeline that is reasonable and practical and is beneficial to all Vermonters. So, if the study moves forward, we're happy to see that. If the desire of the committee is to go in a more expansive way that is both going to provide relief to our two pools, as well as all Vermonters and employers receiving health insurance through some type of reference based pricing model, that is great as well. So that's the origin of the study. No necessary changes. I will say some of the specific language around data. Health and welfare was doing some stuff on the fly in the final days. I'm looking over at Di there. And I think it was Elena who chimed in about some of the data considerations that Sue was speaking about earlier. And she basically recognized when they did their 2024 study, they were using, I'm not exactly sure of the dataset, but it wasn't the perfect dataset. And so the desire was, if we're going to refresh this study, let's use the data directly from the two pools. So, that was the intention of that language, I believe. So, that's section four. Going on to section 10.

[Alyssa Black (Chair)]: Can I

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: ask you a question?

[Lori Houghton (Member)]: Yeah, sure.

[Alyssa Black (Chair)]: Ask you a hard question, please.

[Colin Robinson (Vermont-NEA)]: That's why we're here, right?

[Alyssa Black (Chair)]: I hear your history of reference based pricing, I hear your advocacy on behalf of Vermont NEA and as it pertains to section four and reference based pricing. We sort of First of all, we're all going to reference based pricing. Sure. So we got you covered. But in this bill currently, as currently configured, it contemplates reference based pricing specifically for the QHP market. Other And than taxpayers, let's remove the taxpayer out of your advocacy. Why would I or anyone in this committee or the general assembly, why would we target savings to I should say, should we target savings to a collectively bargained group with a 96% to 97% actuarial rating that effectively has no skin in the game? Or should we target it to the people who actually pay almost every single dollar of that $43,000 premium and have huge deductibles that they're actually responsible for? If you were in my position, who would you target reference based pricing to?

[Colin Robinson (Vermont-NEA)]: So that's why we supported QHP and we support moving there for everybody. So to be clear, I think, and you all know this because you get the emails honestly more than I do, right? But there's a lot of conversation about property taxes. The 2022 study shows a potential $48,000,000 savings to the education fund. That's nearly $05 in potential savings. So I don't necessarily see it as an either or.

[Alyssa Black (Chair)]: Have we done a study on if we changed the plan, the savings, and made the benefits equivalent to other qualified health plans? Have we done that study and how much it would save the taxpayer?

[Colin Robinson (Vermont-NEA)]: The short answer is I think that potentially is some of the things that section 10 could be looking at. What are the potential opportunities in savings there? I will say, VIHI is in the process, the VIHI board, to articulate the composition of the board, is in the process of plan redesign right now. And that will have an impact on what the future of the plans look like for our members, as well as potentially the costs therein. I don't want to mix my testimony in this moment with the bargaining side of things, because I want to be very clear. How we collectively bargain as a union with our employer over the benefits our members receive is impactful. It's impactful on our members, it's impactful on school boards, it's impactful on everybody. The problem that we're looking to address, and I think your committee has done tremendous work trying to address and the care board and others, is a healthcare affordability crisis for all Vermonters. There's nothing unique and VIHI co trust administrators, Bob Joe Sauls and Mark Cage provided testimony to Senate Finance. I believe they've been in this committee before talking about how the main cost drivers in the VIHI pool are no different than any other market that you've heard about. And so the underlying fundamentals are not going to be changed by the contours of how the bargaining process plays out. What is going to have the most substantial change are some of the reform conversations that you've been leading on and that you're continuing to have. So if you want to target, if you choose to target QHPs, as I said in Senate Health and Welfare, as I started by saying today, that's great. We're supportive of that. If there's an opportunity to realize some of those savings more broadly for all Vermonters in whatever way they receive their health insurance, that's great as well. We wanted to provide as an option for the legislature to say, okay, if you want to do something that is going to specifically address a property tax, the commissioner of VFR, I think sort of alluded to that as well in his testimony, this could be an option. So that's the origin of the section four study. Maybe that didn't answer your question, but Okay, thanks, Benny, I appreciate it. Section 10. Yes. Okay, so Section 10, the origin. Did this come from? Did this come from? I do. So Center Lyons approached me and said, Hey, what would you all think about doing a study on a big public sector health insurance plan? And we said, Sounds good, let's talk about it. And so we had some conversations about it, and that is essentially the result of Section 10. To the history of this general conversation, Chair Black was alluding to, we were first approached, I believe in 2003 or 2004 by then Senator Jim Lueders, asking about a big public sector worker pool. Our understanding is this is the first time an actual study would be done. It's never been analyzed, it's never been looked at fully. And I will say, I know as mentioned earlier, I think how you operationalize something like this is fundamental to a study. So, it's not just the various components of it, but it's actual how do you get from A to B. So that's the quick headline. Obviously, as the language references, it references Oregon and Washington state, because those are two states that have moved in the direction of large public sector worker pools. And so there's opportunity to learn from and build upon those types of states. We've talked with the treasurer's office, and we're supportive of their recommendations that they presented on Tuesday to adjust the language in section 10 and are comfortable with that. And I wanna emphasize one final potential opportunity about section 10, recognizing the breadth and scope of it is significant. It's not just the opportunity to have a bigger pool that could potentially afford opportunities for savings, But there's also an opportunity to use that tool to drive innovation through things like direct contracting with centers of excellence, through other types of next gen PBMs and methodologies where that large pool could use its weight to drive some innovations that can be beneficial for everybody. As it relates to the composition of the task force, obviously I had not seen VSVS testimony until just now. I will say the composition of the task force is very intentional in that it has five members representing employers and five members representing the public sector unions that serve within the state college system, the University of Vermont, the State of Vermont, as well as obviously public schools and municipalities. Those are the five unions that are represented there, and you see that mirrored in the employer representatives. I would hope you can appreciate that whenever you talk about, especially if we're talking about rolled up here, maybe 100,000 lives, 80,000 lives, when you start talking about these types of matters, it's very, very important to have the directly impacted stakeholders at the table for those conversations. And I think there's enough expertise and understanding and passion to dig into this in that extended timeline with some of those additions that the treasurer's office recommended, that we could get a good start on starting to understand what is the opportunity here for Vermonters with this type of larger pool.

[Alyssa Black (Chair)]: When you talk about stakeholders with 100,000 lives, who are you talking about as the stakeholders? I see that you have representatives of both the employer and employees. Do employees in the small group market get a seat at the table in their plan design?

[Colin Robinson (Vermont-NEA)]: I don't believe so. Assume that was sort of a rhetorical question.

[Alyssa Black (Chair)]: You're talking about self funded. Yes. I'm trying to think in what world do employees get a seat at the table in the plan design, other than collectively bargained?

[Colin Robinson (Vermont-NEA)]: I mean, fair enough. And I would say as our members as well as the other unions that are represented here have been engaged and come together to engage in those conversations with their employers for decades. And so here's the thing, if there's not a desire to explore this as a potential savings opportunity or innovation driver, that's fine. We're coming to the table here saying this has been something that's kicked around for twenty years. We're ready to have that conversation. We recognize it's a hard conversation for our members, recognize it's a hard conversation for Vermonters, and at the same time, it's worth finally taking a look under the hood. Now is that a different construct than makes it other people? Yes, but we represent Vermont and EA, and in this particular bill, it's contemplating public sector workers who are unionized, who do have a different relationship when it comes to the relationship they have with their employers as it relates to their health care benefits. I think there's great value in that for workers collectively, and I would say every worker should have an opportunity to join a union and be engaged in that conversation.

[Alyssa Black (Chair)]: I'm really pleased to hear you say that you look forward to having the conversation.

[Karen Lueders (Member)]: Karen. Thanks for being here. So I really am very much interested in looking under the hood and seeing where this information leads us and where results in reducing costs and providing quality health care could be

[Lori Houghton (Member)]: what we end up with.

[Karen Lueders (Member)]: So I have a couple of thoughts about the cost drivers in these larger groups, and they're

[Lori Houghton (Member)]: different

[Karen Lueders (Member)]: than elsewhere. One is that there is the actuarial fact that there's no obligation to actually pay out of pocket, so it's very attractive to be in these plans, and so folks try to get on them and that increases the numbers of folks that are on the plans. And then does that not increase utilization? If I can go get this great healthcare coverage for free, why wouldn't I? And then, so that's utilization, and then there's this obligation that we as a community and state taxpayers to provide this, and I think there's a sort of a funding source for it, unlike written books. And so, I mean, I believe teachers should have healthcare, they've bargained for it when they started bargaining for it, maybe they took lower salaries and they had no idea health insurance would do this. And yet, despite all of that good things, I think it is not wrong to think about this scenario as a cost driver contributor, the way this scenario ended. It is actually a cost driver and it shifts a lot of the burden to other folks, not intentionally and not because they don't have bargained for rights. So we're a little bit talking about healthcare as a public good that they should have access to, and not some folks being left out. And we've talked about maybe 5% initially, all folks getting healthcare going into a pot that would fund everyone having access to primary care at least a little bit, and not superimposed. What do you think about that?

[Colin Robinson (Vermont-NEA)]: I'll answer your direct question first, and then get back to a couple of points that you brought up that I feel want to address briefly. We support single payer, we supported the efforts towards Screen Mountain Care Board. We supported and led the effort on Doctor. Dinosaur two point zero to create universal healthcare for all Vermonters aged 26 and under. If the next step on that train is universal primary care for all Vermonters, sign us up. Yeah. So, to your other questions, I do want to spell a quick piece of information here. The terms of the statewide health care agreement outline how deductibles are covered for public school workers, whether a paraeducator, bus driver, food service worker, school counselor, student nurse, teacher. And it covers first dollar of the deductible. That's the structure of the health reimbursement arrangement. It does not cover every dollar of the deductible, but it is first dollar. And as you heard from your witness earlier, when it comes to HRA funding, obviously for budgeting purposes, you're not budgeting the full exposure. There's analysis done to figure out how much needs to go into that account. It's HRA, so it rolls over. It stays employer dollars. When our members leave, it's not an HSA. They don't walk away with that. Doesn't go towards the healthy and wealthy. You can use it to buy a vote when they turn 65. Right? It stays with the taxpayers locally. So there is there. I would encourage the committee, you wanna spend some more time on this, I I forget when the last time you had the VIHI co trust administrators in here, but they have a really comprehensive presentation on VIHI, the VIHI pool, the experience, utilization, all of those things. Last time they were in, I think, was in senate finance on February 6. Anyways, I think there's a lot there to unpack, and I don't wanna misstate or mischaracterize, and so they would probably be the best to kinda speak to some of those questions around utilization. They have a very comprehensive

[Alyssa Black (Chair)]: I think we have them in earlier last year.

[Colin Robinson (Vermont-NEA)]: Yeah, I couldn't remember exactly.

[Karen Lueders (Member)]: I can check back there.

[Lori Houghton (Member)]: Yeah, yeah.

[Colin Robinson (Vermont-NEA)]: Yeah, I'll send it to you as well. I can share it with You can send it to Tasha? I can send it to Tasha.

[Alyssa Black (Chair)]: Any other questions? We've run out of sorry. Go ahead. You may

[Lori Houghton (Member)]: have answered this question, I'm sorry if I missed it. But it was suggested that Section four is redundant by the Green Mountain Care Board and DFR, and that we didn't need it. So I was wondering if you had any thoughts about that.

[Colin Robinson (Vermont-NEA)]: Good question. I will say it this way. We did not request Section four. Section four was sort of, I would say, maybe a release valve from a conversation about other things related to reference based pricing. And so if there is a desire to go a different direction, I think that would probably be okay with us. I do think what the study would show is continued and significant savings potentially realized in these two public sector worker pools for taxpayers.

[Lori Houghton (Member)]: But we could just go ahead and do it, which is what King suggested. Correct, and

[Alyssa Black (Chair)]: we would support that. If you just go ahead

[Colin Robinson (Vermont-NEA)]: and do it, there's no need for a study.

[Alyssa Black (Chair)]: There you go. However, would just ask for it. Ask everybody.

[Karen Lueders (Member)]: I think that would be pretty unfair to what we're doing to the whole education system already, and then we're just going to say, and by the way, your healthcare system

[Alyssa Black (Chair)]: is going to an appeal at the same time.

[Karen Lueders (Member)]: I don't know, I just feel like we're doing, well, I like the study. I'm a public sector employee, so

[Colin Robinson (Vermont-NEA)]: Yeah, no, I know.

[Alyssa Black (Chair)]: You like the section 10, not the study in second section four means

[Karen Lueders (Member)]: Section 10, I like.

[Alyssa Black (Chair)]: It's just the actuarial analysis that's being done all the time. Yes. Thank you. Yes. Thank you. I was going to, you know, Christine, previous, I was going to ask you all sorts of administrative questions and costs on that, but I won't. I'm always happy to come back. Don't want to get into that.

[Colin Robinson (Vermont-NEA)]: Always happy to come back. And if you want to talk more about the bargaining side of things, I think that's outside of the scope and purview of this committee, but I wouldn't say we would happily go there, but happy to explain the contours of that.

[Alyssa Black (Chair)]: Thanks, Colin. Always good to have you in here. See you too.

[Colin Robinson (Vermont-NEA)]: Thank you.

[Alyssa Black (Chair)]: Alright. We can go off of live, and we'll be back here after

[Sue Ceglowski (Executive Director, Vermont School Boards Association)]: the

[Alyssa Black (Chair)]: floor Fifteen minutes.