Comprehensive Reform in Vermont

The Vermont Health Care Affordability Act was passed in 2006 with the goal of insuring 96% of Vermonters by 2010 (20,000 to 25,000 Vermonters). The Reform contains over 35 separate initiatives, all addressing the goals of increasing access, improving quality of care and containing costs.  These initiatives have implementation dates ranging from 2006 through 2011. 

Governance:
The Secretary of Administration for coordination of Vermont's Health Care Reform is responsible for the coordination of Health Care Reform among the executive branch agencies, departments and offices in a manner that is timely, patient-centered and seeks to improive the quality and affordability of health care in Vermont.  In 2006, Susan Besio was appointed as Director of Health Care Reform Implementation in the Secretary of Administration's office to oversee implementation of the state's health care reform.  Reform legislation also created the Joint Legislative Commission on Health Care Reform to monitor implementation of health care reform initiatives and recommend to the general assembly actions needed to attain health care reform goals.

Public Sector:

• Catamount Health Product
  • New affordable health insurance product for uninsured who have been without coverage for one year and are ineligible for other public or employer-sponsored plans
  • Typical non-group market product, with more limited cost sharing ($250/$500 deductible, 20% coninsurance, $10 copay)
  • Capped cost sharing and limits on out-of-pocket costs
  • Zero cost sharing for preventive care and chronic care if enrollees are participants in a chronic care management program (see below)
• Premium Subsidies for Low-Income
  • Sliding scale subsidies <300% FPL
  • Additional premium subsidies to individual with access to employer-sponsored insurance

Insurance Market: None

Employer-Based:

• Employers pay $365 per FTE annual assessment if they don't offer coverage
• Employers who offer coverage must pay the assessment for:
  • Workers ineligible to participate in the plan
  • Workers who refuse coverage and do not have coverage elsewhere

Other: Chronic Care Initiative (Blueprint for Health)

• Public/Private Collaborative promoting healthy community-centered programs and activities, providing self-management tools, improving health information systems, and coordinating care for participants.
• Goals:
  • improve health of those living with chronic disease;
  • prevent the increase in chronic disease
• Based on "Chronic Care Model"
  • Development of statewide database of chronic care information
  • Patient registry for indv and population-based disease management
  • Payment for quality
  • Other patient/provider initiatives

Eligibility: for Catamount Health

• Uninsured Vermont resident, age 18 or older, ineligible for ESI
• Definition of uninsured:
  • Has insurance that covers only hospital care OR doctor's visits, but not both
  • Has not had private insurance for the past 12 months
  • Became ineligible for VHAP or Medicaid
  • Lost private insurance because of job loss, divorce, ended COBRA, death of insurance policy holder, loss of dependent status, change of college/university student status
  • If eligible for ESI plan but under 300% FPL and ESI plan is not approved by the states as comprehensive and affordable OR it is more cost effective to the state to provide premium assistance for Catamount Health than for ESI plan OR cannot enroll in ESI during current period

Financing:

• Increase in Tobacco Tax
• 1115 Federal Waiver: "Global Commitment to Health"
  • VT agrees to cap on Medicaid growth in exchange for ability to use funds for health investments
• Enrollee Premiums
• Employer Assessments

Proposed Additional Initiatives:

• Individual Insurance Mandate –if less than 96% of Vermonters are insured in 2010
• Individual Health Insurance Market Reform
• Healthy Lifestyles Insurance Discounts
• Work groups to study common claims procedures and the potential merging of the individual and small group markets
• Expanding hospital reporting on cost shifting
• Establishes a process to create a uniform, statewide uncompensated care policies for all hospitals
• Multi-payer Database & Consumer Price and Quality Information
  

For more information: Health Care Reform of 2006 website

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