2006 HEALTH CARE REFORM INITIATIVES, QUICK OVERVIEW

The legislation reins in health care costs by offering affordable coverage to all Vermonters and establishing an outstanding chronic care system

The 2006 Health Care Affordability Act is a first step toward achieving the goal of quality, affordable health care for all Vermonters.  This legislation has one overriding goal: controlling the steeply rising costs of health care.  It accomplishes this in two ways: by better managing chronic care and making health care affordable and accessible for all Vermonters.  

MAKING HEALTH INSURANCE AFFORDABLE AND ACCESSIBLE TO THE UNINSURED

• The act establishes a health insurance program called Catamount Health.  Under this plan, everyone who is uninsured for 12 months will have access to - and will help pay for - a comprehensive health insurance package. The benefits will be administered through the private market and premiums will be based on income. Under the plan, everyone pays their fair share through an affordable premium structure. In addition, employers will pay an assessment based on the number of their employees who are uninsured. We estimate that at least 25,000 Vermonters who are now uninsured will obtain health coverage. 
• Benefits of Catamount Health include:
• Primary care, preventive and chronic care, acute episodic care, and hospital services.
• Reimbursement for medical services equal to ten percent above cost.
• 25,000 estimated to enroll, including new Medicaid enrollment.
• Chronic care management.
• The financing of Catamount Health is fair and fiscally responsible. 
• Based on the principle that everybody is covered and everybody pays
• Individuals pay sliding scale premiums based on income
• Employers pay an assessment based on the number of their employees (measured as full time equivalents) who are uninsured, exempting the first eight FTEs in fiscal years 2007 and 2008, six FTES in 2009, and four FTES in and after 2010
• Other revenues from increases in tobacco taxes and through matching federal dollars
• State fiscal obligations protected through caps on enrollment

IMPROVING HOW WE DELIVER HEALTH CARE

• The act helps deliver the right care at the right time to the most expensive health care consumers – those with chronic conditions.  It makes chronic care management available to every Vermonter, whether privately insured, covered under a public program, or currently uninsured.  Chronic conditions consume 70 percent of the cost of health care in Vermont. Chronic conditions are what Vermonters worry about most.
• The plan will establish an outstanding system of chronic care management.  This system - available to all Vermonters - will provide:
• Early and coordinated screening for chronic conditions like diabetes or asthma.
• Better management of chronic care.
• Emphasis on patient self-management.
• Payment to providers that rewards quality and disease management, not just quantity. The system will reimburse providers for doing what we want them to do for those with chronic conditions -- manage their care.  For example, calling patients and reminding them to come in for regular check-ups, visiting patients in their home, and doing the necessary follow up.
• The act also codifies the Vermont “Blueprint for Health” prevention and chronic disease management plan and directs chronic care management in Medicaid and Catamount Health that will save an estimated 5-10 percent in health care costs.

EMPLOYER SPONSORED INSURANCE INITIATIVE

· Uninsured Vermonters will receive assistance to purchase the health insurance plan offered by their employer.

· Individuals currently eligible for or enrolled in the Vermont Health Access Plan will be eligible for the new ESI initiative as will uninsured Vermonters who are eligible for Catamount Health Assistance

· The state will do a cost-benefit analysis to ensure that it is cost-effective to provide help to an individual through this program and will protect individuals through a minimum standard for employer plans.

IMMUNIZATIONS –Every Vermonter will be able to receive CDC recommended immunizations for free after October 1, 2007.

MEDICAID INITIATIVES

• The act reduced premiums for low-income individuals and families receiving health care coverage through the Vermont Health Access Plan (VHAP) by 35% and through Dr. Dynasaur by 50%.
• A chronic care management program will be instituted in the Medicaid programs to ensure that low-income Vermonters receive the best quality care when they need it.

COMMON SENSE INITIATIVES

• Community Wellness Grant Program
• Information Technology Coordination
• Loan Repayment for Health Care Professionals
• Healthy Lifestyles Insurance Discount
• Common claims, procedures and credentialing administrative simplification
• Multi-payer Database and Consumer Price and Quality Information
• Medical Event Reporting and Hospital Infection Reporting program
• Safe Apology program