H.524 Green Mountain Health

June 3, 2005

By 2009, Vermont will have an integrated health care system which provides all Vermonters with access to affordable, high quality health care that is financed in a fair and equitable manner.

Green Mountain Health will provide primary and preventive health care coverage to all uninsured Vermonters beginning July 2006; benefit package recommended by the legislative Commission on Health Care Reform with approval by the legislature.

Green Mountain Health will offer, upon finding that cost containment and performance benchmarks will be met:

• primary and preventive health care coverage to all Vermonters in July 2007
• hospital coverage to all Vermonters in October 2008
• a common benefit to all Vermonters in July 2009

Cost Containment – Cost control initiatives address financing, delivery, and quality of health services.  These cost containment measures include:

· Global budgeting of and payments to hospitals

· Chronic care initiative

· Consumer access to health care price and quality information

· Health care information technology initiative

· Alignment of health care professional reimbursement with best practices and outcomes

· Integrated systems of health care

· Health care purchasing pool

· Prescription drug initiatives, including statewide preferred drug list, pharmacy discount plan,  pharmacy benefit manager regulation, and manufacturer price disclosure

· Options for medical liability self-insurance; Safe apology

· Healthy lifestyles insurance discount

· Expansion of health centers and free clinics

Financing - “Health Effort Tax” – all are covered, all contribute - reducing the cost shift

• Employers
• Employers who spend at least 3% of payroll on health care will pay nothing
• Small employers ($50,000 payroll) who spend at least 1% on health care will pay nothing
• Employers not making minimum contribution will pay 1% of first $50,000 and 3% of remaining payroll (minus any health care spending)
• Individuals
• Individuals with health coverage in 9 months of the reporting year will pay nothing
• Individuals without health coverage will pay 1% of adjusted gross income

Quality/ Integrated Systems of Care – The Commission on Health Care will direct a program to assist communities, regions, and health care providers in reorganizing health care delivery systems to improve coordination, quality of health care, and make long-term investments in systems, technology, and infrastructure.

Process/ Studies

• Vermonters will have opportunities to provide input through a public engagement process in summer/ fall 2005.
• Studies during summer 2005 will examine economic impacts, financing options, governance and administrative issues.
• Independent legislative Commission on Health Care created and staffed to provide leadership and follow-through on health care reform