MEMBERS ABSENT:

Also Present:

Legislative and Joint Fiscal staff, members of the Administration, and the public.

Meeting Recorded:

CD HCRC 8/22/07, CD #1 and #2.

Documents Distributed:

1. Recommendation to Emergency Board re Catamount Health and the Global Commitment Waiver                                                                                                                      CD #1, TR 1

--Jim Hester, Susan Besio

Susan Besio distributed the packet of five documents and explained each one.

• The Health Care Contribution Report is very close to our financial models.
• The Key Points document covers 3 major areas:
• Enrollment and total newly insured has the same take up rate assumptions, reflects updated estimate of uninsured
• Changes in estimate of Catamount PMPM  (per person per month) reflects actual Catamount for FY08 and revised estimates for FY09-FY10
• For the Catamount Fund Revenue Estimate - $ millions, the February estimate assumed federal matching to 300% and impact of H.229; the August estimate assumes program subsidy for FPL to 300% and federal matching to 200%.
• The Catamount Big Picture Financial Projection Comparisons lays out five scenarios:
• Where we were
• Where we would have been
• Where we are
• Where are we going— Commitment of  General Funds
• Where are we going— Alternative - $3.5m GF in FY08 & possible match to 300% FPL from 1/1/09

Discussion: Pres. Bush's current planned SCHIP cuts; national pressure to restore cuts which would enable CMS to consider approving request for 200% to 300% of FPL (so 5th scenario above is quite possible); these additional dollars from General Fund will not cut current programs but will decrease available funds for state in the future.

There are reliable sources for additional funds needed for Catamount (per JFO staff) in FY08: increased state revenues from captive insurance companies. JFO has revised upward the FY08 revenue projection based on this revenue.

Commissioners raised concerns re the projections in outer years.

Besio: This proposed amendment and the financials are Governor Douglas’s commitment to funding Catamount Health, to make this program whole.

• Text from Act: “Sec. 106. Catamount Health Assistance; Global Commitment Waiver”

Besio reviewed the options for the Commission’s recommendation, as laid out in the statute.

• Proposed Motion, Catamount Health Fund

Text:

PROPOSED MOTION

Catamount Health Fund

Whereas the Douglas Administration, the Health Care Reform Commission and the legislative leadership continue to be committed to a policy of the state of Vermont to ensure universal access to and coverage for essential health care services for all Vermonters as stated in Section 1 of Act 191 of 2006 (AN ACT RELATING TO HEALTH CARE AFFORDABILITY FOR VERMONTERS).

Specifically our goal, as stated in 2 V.S.A. §902(a)(3)(D) is no less than 96% of Vermonters having health insurance by 2010.  We recognize that providing premium subsidies to uninsured Vermonters who have incomes less than or equal to 300% of the Federal poverty level is a key to realizing that goal.

Whereas the Catamount Health Fund used to finance those premium subsidies must remain financially solvent over the long term, even in the possible absence of Federal support for Vermonters with incomes over 200% of the Federal poverty level.

The Emergency Board approves the following allocation of general funds over the next three years to ensure sufficient funds in the Catamount Fund in order to proceed with implementation of the Catamount Health Assistance program for uninsured Vermonters with incomes less than or equal to 300% of the Federal poverty level:

1.      In FY 2008        $3.5 Million

2.      In FY 2009        $7.5 Million

3.      In FY 2010        $7.5 Million

It is understood that the above amounts may be reduced in the event that one or both of the following occur:

·       The Federal government approves federal match for premium subsidies that will offset some of the cost

·       The Emergency Board adopts revised consensus caseload or per member cost estimates that impact the program financing 

There was extended debate on the need for and wording of the proposed motion: this does not bind future legislatures; needed to assure Vermonters that we are committed to funding Catamount Health; language for various alternative motions was proposed and discussed.

An alternative language:

Motion by Sen. Racine: “The Health Care Reform Commission recommends to the Emergency Board that the state continue with the implementation of Catamount Health established under [include all language from Sec. 106].

Seconded: Sen. Mullin.

Discussion, including more alternative language and possible friendly or unfriendly amendments. Discussion resulted in a group of three proposed motions.

Rep. Larson proposed a substitute motion: ”The Health Care Reform Commission recommends that the Emergency Board support the allocation of $7.5 million if necessary in fiscal years 09 and 10 respectively to support the implementation of Act 191.”

There was no second.

The Commission then voted on the set of three motions:

1.  The Health Care Reform Commission recommends that the Emergency Board recommend to the legislature that an additional $3.5 million in General Funds be appropriated to Catamount Health in fiscal year 2008.

All in favor: 10. Opposed: 0

2.   The Health Care Reform Commission recognizes the commitment of the Douglas Administration to allocate $7.5 million in General Funds if necessary in fiscal years 2009 and 2010 respectively to support the implementation of Act 191.

Second: Rep. McFaun.

All in favor: 10. Opposed: 0

3. Pursuant to section 106 (a) (1) of Act 65 of 2007,  the Health Care Reform Commission recommends  “to proceed with the implementation of the Catamount Health established under 4080f of Title 8, Catamount  Health Assistance under subchapter 3a of Chapter 19 of Title 33, employer-sponsored  insurance program under section 1974 of Title 33, or a combination of the programs.” 

All in favor: 10. Opposed: 0

Staff will send these three motions to the Administration and will prepare them for the Emergency Board meeting tomorrow.

2. Update on the upcoming Commission meeting in Bennington, next Thursday,

August 30

In the interest of time, Jim Hester will send an e-mail out to Commission members with information.

The meeting adjourned at 5:45 PM.

Respectfully submitted,

Loring Starr