Since Governor Shumlin abandoned plans
for establishing a universal health care system, popularly known as a
single-payer system, the House Health Care Committee has been trying
to improve the system we currently have. Vermont Health Connect
continues to have operational issues with regard to processing change
of circumstance filings, and the Committee is continuing to require
updates from the Administration. The Committee's main focus,
however, is to address the affordability of health insurance for all
Vermonters through H.481, which was voted out of committee and will
be acted on by the full House.
H.481 addresses the Medicaid cost
shift, provides additional assistance to under-insured Vermonters,
allocates additional resources to support primary care providers and
the Blueprint for Health, and increases funding and responsibilities
of the Green Mountain Care Board. The bill also provides funding to
pay for these reforms and policy changes. Here are the details.
Addressing the Medicaid cost shift:
This bill provides funding, to be matched with $1.10 of federal
funding for every state dollar, to reduce the Medicaid cost shift.
By increasing reimbursement rates to health care providers serving
Medicaid patients, it reduces the cost pressure on the 54% of
Vermonters who purchase their health insurance privately. It also
enhances access to the health care system for Medicaid patients.
Helping the under-insured:
While the Affordable Care Act has reduced Vermont's uninsured rate
from 7.6% in 2009 to 3.7% in 2014, the second lowest in the nation,
many of the newly insured have plans that are unaffordable – high
deductibles, co-pays, and out-of-pocket maximums. H.481 increases
the cost-sharing subsidies for Vermonters at 200%-300% of the federal
poverty level (family of 4 with income between $48,500 and $72,750)
reducing deductibles from over $3,000 to $1,200 and cutting the
out-of-pocket maximums from over $6,000 to $2,500.
Strengthening primary care:
Primary care providers are the most cost-effective health care
resource, and H.481 targets them for increased resources in Vermont’s
health care system. H.481 takes advantage of 10:1 federal match
dollars in funding Health Homes, provides educational loan
forgiveness to encourage primary care providers to practice in
Vermont, and funds a study on providing state-funded universal
primary care in Vermont.
Strengthening the Blueprint for
Health (B4H): B4H organizes health care resources at the
community level to coordinate services for patients. The focus is on
primary care and preventative medicine, moving Vermont from reactive
to proactive health care. Since 2006 it has been proven to save
money and improve outcomes. H.481 increases B4H state funding by $2M
in FY’16 supplemented by $1.22 in federal match for every Vermont
dollar.
Strengthening the work of the Green
Mountain Care Board: The GMCB has been effective at managing
costs in Vermont’s hospital system. Funding in H.481 allows the
GMCB to establish rate setting protocols that address the Medicaid
cost shift and the pursuit of the All-Payer rate which will allow us
to establish a payment system whereby providers are paid to support
improved outcomes instead of quantity of care.
H.481 also includes three tax
proposals. First, it repeals the Employer Assessment that was used
to pay for the Catamount Health system. While Catamount Health no
longer exists, this assessment continues to be paid into the Health
Care Resources Fund by employers that do not provide health insurance
to their employees. Repeal will save these businesses $4.4M in
FY’16. Secondly, it establishes a 0.3% Payroll Tax, a reduction
from the governor’s original 0.7% proposal, which would be levied
on all employers. It is expected to raise $17.8M in FY’16.
Finally, it assesses a 2 cent/ounce excise tax on sugar-sweetened
beverages. The Health Care Committee has heard extensive testimony
from the medical community who believe that a major contributing
factor to the increased prevalence of obesity and type-2 diabetes is
the increased consumption of sugar-sweetened beverages. This tax is
anticipated to raise $30.9M in FY’17 revenue.
In a separate companion bill that
received unanimous support, the Health Care Committee adopted a
provision authorizing direct enrollment with insurance carriers for
individuals within VT Health Connect effective November 1, 2016, the
beginning of the next open enrollment period. This is intended for
individuals not receiving subsidies who wish to work directly with
their health insurance company.
I continue to welcome your feedback on
this and other issues. I can be reached by
phone (802-233-5238) or by email (myantachka.dfa@gmail.com).
