H.861 Senate Proposal of Amendment

Ideas Under Consideration

  • Blueprint for Health – Chronic Disease Prevention & Care Management Initiative
    • Build on the House proposal by specifying governance structure
  • Catamount Health (Oct. 1, 2007)
    • A self-insured health care benefit for uninsured Vermonters
      • For uninsured Vermonters without access to employer sponsored insurance, a benefit package equivalent to that of the average commercially insured Vermonter
        • Sliding-scale premiums for individuals with incomes under 350% of federal poverty level ($70,000 for a family of 4)
        • Benefit available at full cost for the uninsured with incomes over 350% FPL
        • Reinsured with a private carrier to protect the state against catastrophic costs
        • Reimbursement to hospitals at 110% of costs in first year; cost containment by limiting increases to Medicare economic index
        • Operated by a private third-party administrator
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      • Sliding scale premium assistance for individuals with incomes under 350% of FPL who have access to employer-sponsored coverage that is comparable to Catamount Health
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      • A focus on chronic disease prevention and care management;
    • Universal access to a limited number of diagnostic or other services (for example, immunizations; pap smears)
  • Premium Relief  for the Individual or Nongroup Insurance Market
    • Reinsurance or other assistance offered to insurers with products in the individual market to reduce premium cost for individuals
  • Cost Shift Reduction
    • Reduce amount of bad debt and charity care through covering the uninsured through Catamount Health and other existing programs
    • Enhance BISHCA’s authority to review rates to ensure reductions in the cost shift are passed through to consumers
    • Hospital Default Insurance
      • Establish minimum criteria for hospital uncompensated care programs to ensure statewide uniformity
      • Create an uncompensated care pool to pay for and track the use and expenditures for uncompensated care
      • Set aside funds from insurance premiums or payments into the uncompensated care pool to match through Global Commitment
      • Use premium assessed on employers who do not offer insurance to fund pool
  • Increase in Medicaid rates for primary care
  • Vermont Health Access Plan (VHAP) – employer sponsored insurance
    • premium assistance for individuals enrolled in the Vermont Health Access Plan (VHAP) who have access to employer-sponsored insurance
  • Everyone contributes and other financing
    • Premium assessed on employers who do not offer insurance; use for hospital default insurance pool
    • Possible financing through a 60 cent increase in the cigarette tax, tobacco settlement strategic payments, and the Global Commitment to Health.
  • Next steps:
    • extend universal access to additional diagnostic or other services
    • explore methods for underinsured individuals (for example, those whose health care costs are more than 10% of their gross income) to access Catamount Health
    • explore options for individuals in high cost markets
    • in 2010, determine if a health insurance requirement is necessary in 2011 to achieve universal coverage