115 State Street |
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SEN. M. JANE KITCHEL, CO-CHAIR
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STATE OF VERMONT |
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GENERAL ASSEMBLY |
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COMMISSION ON HEALTH CARE REFORM |
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MINUTES |
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Tuesday, October 23, 2007 |
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State House, Room 10 |
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Montpelier, VT |
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115 State Street |
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SEN. M. JANE KITCHEL, CO-CHAIR
|
STATE OF VERMONT |
|
|
GENERAL ASSEMBLY |
||
COMMISSION ON HEALTH CARE REFORM |
||
MINUTES |
||
Tuesday, October 23, 2007 |
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State House, Room 10 |
||
Montpelier, VT |
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MEMBERS PRESENT: | SEN. M. JANE KITCHEL, CO-CHAIR, REP. STEVEN MAIER, CO-CHAIR, SEN. ANN CUMMINGS, SEN. KEVIN MULLIN, SEN. DOUG RACINE, REP. HARRY CHEN (via phone), REP. FRANCIS MCFAUN, JOHN BLOOMER, JR. |
MEMBERS ABSENT: |
REP. MARK LARSON, WALTER FREED |
Also Present: |
Legislative and Joint Fiscal staff, members of the Administration, and the public. |
Meeting Recorded: |
Meeting recorded: CD HCRC 10/23/07, CD #1, 2 & 3 |
Documents Distributed: |
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| Witness List: |
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1. Convene,
Convene, Review and Approve Meeting Minutes Rep. Maier and Sen. Kitchel convened the Commission meeting at 1:15 PM. The Commission approved the minutes. 2. Implementation Updates a. Catamount Health implementation 10/1 Susan Besio Document distributed:
Call center is getting about 149 calls a day, most are enquiring about Catamount Health premium assistance. Applications through the carriers: 23 at full cost; 19 with premium assistance. Re potential eligibles: both BCBS and MVP have made a wonderful accommodation: giving retroactive coverage where there have been gaps. The State has determined 869 eligible so far; have processed 2,839 applications and sent out eligibility information request letters (PIRLs: Plan Information Request Letters). So it is really picking up, especially compared to the earlier estimates. Update re regional trainings: trainings will continue this fall, at all the hospitals. High-level information, re eligibility, call numbers, screening tools and web site. Update re employer contribution: Document distributed:
The amount is similar to the last report. 2. c. Brief update on immunizations: The will have more information at the November meeting. Susan Besio also mentioned the informational meeting being held for legislators by the Dept. of Health: Nov. 20, before the next HCRC meeting. In other news, they have partnered with two organizations, Robert Wood Johnson re evaluation studies, and the University of New England and the Muskie School—both of these organizations are in Maine. Both of the proposals have been accepted in a first round; they will work on the full proposals in December. Finally, she wanted to acknowledge the work of the people at OVHA: they have put in long hours and done tremendous work. CD #1, Tr. 2 Discussion: trainings, schedule, contents, who they are reaching out to for these regional trainings. 2. d. Enrollment Simplification Presentation Meryl Friedman-Price, from Health Policy Matters Beth Waldman, Bailit Health Purchasing, LLC Document distributed:
Their goal: to work with the state to decrease the number of people who are eligible but unenrolled. They held a series of stakeholder meetings; a broad input process. Reviewed best practices, including other states. Findings: IT is really impossible to make something that is very complex simple: Medicaid is so very complex. Vermont has done an excellent job of enrollment. Re applications: They suggest combining some of the applications; making the process simpler. Could reduce the applications from five to three. Combine into one: all the applications for those under age 65. Make a streamlined renewal form. This has worked in other states. Extend the application period beyond the current 30 days. Re the assets test: Try to get an amendment to the Medicaid Waiver to eliminate the asset test for those under age 65. Also look at removing the spend-down for people with disabilities. This would need careful study. The application itself: They presented several detailed suggestions from their report. Application very difficult to create at a 6th grade reading level. Re presumptive eligibility: In Vermont, there would be little to be gained. Vermont already does most of this. They also discussed the auto-enrollment situation in Massachusetts. Vermont needs a user-friendly document, up front. Needs a handbook re all programs, eligibility, benefits. Could then make notices simpler. They gave more details on revising notices. Re the overall application process: 1. Make sure that all the advocates are fully aware of all resources. 2. Important for the state to back up and collect data—to make sure they are developing the right interventions, so don’t waste work. Perhaps do a short-term study of why people don’t return applications they have been sent. Also: leverage resources of the provider community, to track charity care. Check the ROI re expanding the hours of customer service, to see if this really adds value. Next steps: the Administration is reviewing these recommendations; and prioritizing. (The summary of recommendations is Exhibit A, page 22 in the Report.) Susan Besio: This study was commissioned by the Administration, as part of the Outreach and Enrollment process, and is part of that budget. Discussion followed re benchmarks, evaluations of the most effective parts of the outreach process. 2. b. Sorry Works! Update CD #2, tr. 1 Christine Oliver, BISHCA Documents distributed:
The rules are on hold, because to date there are no entities willing to participate. So they at BISHCA are working with interested parties to determine how to facilitate a more viable Sorry Works! program. Rules would be premature at this point. Any hospital could work with this program, without rules, especially with the national Sorry Works! program. Some insurance carriers are showing interest. 3. Non-Group Market CD #2, tr. 2 Christine Oliver, BISHCA Document distributed:
3. a. As a reminder, these are the recommendations from Eliot Wick from last winter. The Reinsurance Trust did NOT get funding in the budget from the Waterfall. Oliver went through the key topics raised in Wicks’ report, of which BISHCA has identified five as potentially fruitful topics for further examination by the General Assembly:
Discussion of item number five followed, with comments from Paul Harrington of the Vt. Medical Society and Kevin Goddard of BCBS. 3. b. The Non-Group Market Trust was funded at $1 million; this money will go back. 3. c. BISHCA follow-up: See the Memorandum; BISHCA will be making a recommendation. 3. d. Blue Cross CD #2, Tr. 3 Kevin Goddard, BCBS He suggests further work by policy-makers re the non-group market. The 75% Rule was designed to encourage coverage, not to deny it. There are other populations, beyond the uninsured, in the non-group market: people who have no health insurance through their employment. They face difficult decisions whether to buy or not to buy. Result: BCBS currently has about 2,700 in this pool. They face high rates and high deductibles. Can face up to $10,000, or more, in out-of-pocket cost before the get any benefits. BCBS is being forced by economics to decrease benefits, etc. Discussion followed on adverse selection. BCBS has lost money on this market in 20 of the last 22 years. They urge unifying these risk pools. There are also about 2,800 in BCBS’s Safety Net program. He believes that MVP has some separate small pools as well. All these pools have different regulations, etc. They need help with this individual market issue. Suggestion: Require that everyone purchase health insurance. (Christine Oliver: The small group market in Vermont is very unusual—combining with the individual market would not create a saving.) Question: In a close analysis of the data, who exactly in generating the most costs? A (Goddard): We will go back and analyze the data. 3. e. MVP Healthcare CD #2, Tr. 4 Bill Little, MVP Document distributed:
Little: Before we make more changes, we need to see the results from Catamount. If we combine these small pools, what will be the impact on all the other rate payers? If we move from community rating to age rating, there will be differing impacts. Their concerns include:
4. Workgroup #1, Expanding Affordable Coverage CD #2 Tr. 5 Jim Hester Documents distributed:
Hester: For Workgroup #1, there are three fundamental questions:
Today he will focus on questions 1 and 2. Re the target of 4% uninsured: given current projections, we will need between 20,000 and 25,000 more enrollees. Could expand premium subsidies beyond 300% of federal poverty level; reduce the waiting period for coverage; or add a financial hardship category. CD #3 Tr. 1 There was a discussion of these various options. CD #3 Tr. 2 Re the Workgroup #2 question #2, How to improve the health coverage for the ‘underinsured’ population and significantly expand the population benefiting from health care reform?: The Workgroup has prepared five options and sub-options; see the attached document. 5. Commission Workgroups Jim Hester CD #3 Tr. 3 a. Overview of workgroup and commission process for November The meeting for WG #3 is scheduled for Nov. 7. We have not yet scheduled the meeting for WG #4. At the Nov. 20 Commission meeting, we will present a draft document which will pull together all the major options from all five workgroups. From this, the Commission will craft an overall package of recommendations for major health care reform legislation for 2008. Discussion followed, re Workgroup #3, especially hospital costs, and the agenda for the WG #3 meeting. b. Summary of Work group #4: Health IT EHR (Electronic Health Record): Moving from the pilot program to more complete funding, and are considering fundraising options. Looking at both capital costs and funding for ongoing support. There are also other issues for legislative action re VITL’s work. c. Next commission meeting: November 20, Montpelier The meeting will be combined with a briefing from the Vermont Department of Health. Re another off-site meeting for the Commission: it is not feasible to fit in another off-site meeting, given timing. The meeting adjourned at 4:15 PM. Respectfully submitted, Loring Starr |
