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
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
- 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
- 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
- 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.
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.
Vermonter will be able to receive CDC recommended immunizations for free after October 1, 2007.
- 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
- 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
- Information Technology
- Loan Repayment for Health Care
- Healthy Lifestyles Insurance
- 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