SUMMARY:

THE 2006 HEALTH CARE AFFORDABILITY ACT

 

The legislature is committed to quality, affordable health care for all Vermonters, and this is a first step toward achieving that goal.  This legislation has one overriding goal: controlling the steeply rising costs of health care. 

 

THE HEALTH CARE AFFORDABILITY ACT WILL CONTAIN COSTS BY:

 

IMPROVING HOW WE DELIVER HEALTH CARE

  • H.861 helps deliver the right care at the right time to the most expensive health care consumers - the chronically ill.  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 diseases are the diseases 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 disease.
    • 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 illness -- 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.
  • Codifying the Vermont “Blueprint for Health” prevention and chronic disease management plan and directs chronic care management in Medicaid and Catamount Health through contracted services that, based on experience in other states, will include a guarantee of net savings to the state or will put company fees at risk if costs are not reduced.  

 

MAKING HEALTH INSURANCE AFFORDABLE AND ACCESSIBLE TO THE UNINSURED

  • The bill establishes a health insurance program called Catamount Health.  Under this plan, everyone who is currently uninsured will have access to - and will help pay for - a comprehensive package of benefits. The benefits will be administered by a private, third-party entity, and premiums will be based on income. Under the plan, everyone pays their fair share through an affordable premium structure. We estimate that at least 20,000 Vermonters who are now uninsured will now have coverage. 
  • Health benefits of Catamount Health include:
    • Primary care, preventive and chronic care, acute episodic care, and hospital services – similar to Point of Service plan offered to state employees
    • Reimbursement for medical services = Medicare rates + 10%
    • Financing: individuals pay sliding scale premium based on income for those under 350% of federal poverty level
    • 21,000 estimated to enroll, including new Medicaid enrollment.