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
- 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
- Emphasis on patient
- 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
- 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
- 21,000 estimated to enroll,
including new Medicaid enrollment.