Green Mountain Care Board urges caution on insurer governance, executive pay and age‑rating changes

Joan Foster, chair of the Green Mountain Care Board, and Emily Brown, the board’s executive director, testified that the bill’s governance changes — adding public representatives appointed by government to the board of directors of a domiciled insurer — would increase transparency and provide oversight that better aligns insurer decisions with statewide health goals.

Foster pointed to recent examples of large executive compensation increases during periods of financial stress at large nonprofit providers and insurers, saying greater public oversight of compensation benchmarks and peer-group surveys could reduce incentives that conflict with state affordability goals. She noted the bill would require insurers to provide compensation benchmarks and surveys to the Department of Financial Regulation, which could require changes the regulator deems inappropriate.

The board also addressed a proposal to allow limited age rating (a cap discussed in testimony at about 5%). Witnesses said modest age rating might help keep younger, healthier people in the Qualified Health Plan market — which could improve pool morbidity — but emphasized the need for Vermont-specific actuarial analysis to show whether the threshold would achieve the intended effect without harming older enrollees.

On association health plans and short-term, limited-duration products, Foster and Brown warned these options could shrink the QHP risk pool (by moving healthier lives out of the exchange) and therefore raise premiums for those who remain; both urged modeling and careful rulemaking. The board supported a narrowed prior-authorization exemption for nonhospital primary care and cautioned that a site-neutral billing provision overlaps existing Act 68 rulemaking and could be administratively duplicative.

What’s next: Foster and Brown asked DFR and legislative staff for actuarial models and timelines to quantify effects on enrollment, subsidies and premium costs; the committee agreed to request more analysis and rescheduled some insurer witnesses for a later session.

Representative excerpts: Foster said insurers’ peer-group surveys and benchmarking should be reviewable by regulators, and that "executives are rightfully motivated by their incentives, and we need to make sure that we're incentivizing them towards the right thing for the state."