DETAILS ABOUT THE 2006 HEALTH CARE AFFORDABILITY ACT
H.861 Committee of Conference - May 5, 2006
Who is eligible for Catamount Health?
· Only uninsured Vermonters are eligible for Catamount Health. An uninsured person is defined as someone who:
Ø Does not qualify for Medicare, Medicaid, VHAP, Dr. Dynasaur
Ø Has not had private or employer-sponsored insurance that includes both hospital and physician services for the last 12 months
§ If a person has only catastrophic coverage for hospital care, for example, s/he is defined as uninsured for purposes of Catamount Health and does not need to wait 12 months
Ø Has lost private or employer-sponsored coverage during the last 12 months because of: loss of employment, death of the principal insurance policyholder, divorce or dissolution of a civil union, no longer qualifying as a dependent under the plan of a parent or caretaker relative, no longer qualifying for COBRA, VIPER or other state continuation coverage.
Ø Lost college or university-sponsored health insurance because of graduation, leave of absence or otherwise termination of studies.
· An individual 18 or older who is claimed on a tax return as a dependent of a resident of another state is not eligible for Catamount Health.
What are the enrollment figures? What about requiring that everyone have insurance?
Ø eliminating some or all of the 12-month waiting period
Ø allowing the underinsured to buy into the plan
Ø allowing employers to buy into the plan
How is Catamount Health financed?
Ø The tax on cigarettes is increased $0.60 to $1.79 per pack on July 1, 2006
Ø The tax on cigarettes is increased an additional $0.20 to $1.99 on July 1, 2008
Ø Little cigars, roll-your-own tobacco will be taxed as cigarettes
Ø Snuff – changing tax to a per-ounce tax
How will the employer assessment work?
Ø All employees of employers who do not offer insurance to anyone.
Ø Employees of employers who offer insurance to some employees, but who are not eligible themselves.
Ø Employees who are eligible for coverage through their employer plans, but choose not to enroll, and are uninsured.
How is a chronic condition defined?
· A chronic condition is defined as an established clinical condition that is expected to last a year or more and that requires ongoing clinical management.
· Examples include: diabetes, high blood pressure, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental illness, high cholesterol, and spinal cord injury.
What’s wrong with chronic care now?
· Our current health care system was designed decades ago to treat acute health situations. We would go to the doctor only when we were sick and doctors would treat or prescribe or operate, and then send us home. Except for children and pregnant women, our health care system rarely focused on prevention or actively promoting and managing health.
· Approximately 75% of all health care spending today is for people with chronic conditions. In general, our medical system does a poor job with these people. Well documented and accepted national studies indicate that people with chronic conditions receive the right care at the right time only about 55% of the time. These people are suffering for it and we are all paying for it.
How will the new chronic condition management system work?
· We have to change the focus from treating episodic illness to managing chronic conditions.
· Key to the success of such a system is working closely with primary care providers and paying them to coordinate care for those with chronic conditions. For example, a successful system will make sure that cancer survivors get the periodic tests they need to make sure their cancer has not recurred.
· This year's bill will re-engineer our health care delivery system to better deliver the right care at the right time. More people with diabetes, for example, will receive their eye and extremity exams and fewer will end up blind or with leg amputations. We also will focus more on prevention and early treatment. Dr. Thorpe estimates that these system changes will result in system-wide savings of $550 million over the next ten years relative to what we would otherwise experience.
· The new chronic care model will be available to every Vermonter with any type of health plan, not just to people in Catamount Health and Medicaid.
How does Employer Sponsored Insurance (ESI) work?
What about people who currently have insurance? What does this bill do for them?
Ø A significantly improved chronic care management program for all Vermonters will reduce spending by $550 million over 10 years.
Ø By covering the uninsured, we will cut into the current 7% added costs that are built into private insurance premiums to cover the health care costs of the uninsured.
Ø Administrative simplifications will save money.
How can we be sure that savings from reducing the cost shift will pass through to premiums?
How will H.861 strengthen primary care?
· We have learned that Vermont’s primary care system is in distress. Doctors are working harder and harder to make ends meet, some regions of the state have shortages, recruitment and retention are problems everywhere, and medical students are choosing specialty areas over primary care.
· Stable and expanded primary care capacity will be needed for chronic care services
· The bill includes several provisions that will strengthen our primary care practices:
Ø increases Medicaid reimbursements for primary care services – increased to Medicare rates
Ø pays in new, innovative, and more appropriate ways for chronic care services
Ø expanded loan repayment program (included in the budget)
What about the Medicaid deficit? Will passing this bill make it worse?
· H.861 will not make the looming Medicaid deficit worse. In fact, it will reduce the deficit by:
o Delivering chronic care in a better and more cost-effective manner
o Appropriating funds for items currently in the Governor’s budget request, such as the Vermont blueprint for health and increased Medicaid reimbursement.
· All of the state costs related to H.861 will be paid for with new revenues.
· The new “global commitment” Medicaid waiver specifically allows for new federal matching dollars for programs for the uninsured, although a waiver amendment will be required.
· There is sufficient room within the global commitment “cap” to pay for H.861, with about $100 million left over.
How is H.861 different from last year’s bill?
Where do you go from here?