Download - Comprehensive Health Care Reform in Vermont:
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Comprehensive Health Care Comprehensive Health Care Reform in Vermont:Reform in Vermont:
The Policy and PoliticsThe Policy and Politics
Jim Maxwell, PhDJim Maxwell, PhDHerb Olson, JDHerb Olson, JD
JSI Research & Training Institute, Inc.JSI Research & Training Institute, Inc.
Vermont Department of Banking, Insurance, Securities and Vermont Department of Banking, Insurance, Securities and Health Care AdministrationHealth Care Administration
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OverviewOverview
• Context for 2006 health care reform• Program elements• Implementation status and
challenges• Lessons for state and national reform
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• Vermont is “unique,” but has many similarities to other states
– Health care costs rising faster than the national average
– Obesity, smoking, and substance abuse major cost drivers
– Uninsured rate rising– Higher deductible plans increasingly
attractive to small businesses– Medicaid program facing fiscal sustainability
problems
Policy ContextPolicy Context
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• 2006 reform result of compromise between democratic legislature and republican governor
• Key compromise: to rely on private rather than public insurance programs
2006 Catamount Health Reforms
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• Medicaid Access Initiatives
– Premiums for children have been reduced by 50%
– Premiums for Medicaid adults have been reduced by 35%
– Education, outreach, and marketing to Medicaid eligible
Program Components
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• ESI Premium Assistance Program
– Uninsured Vermonters with income less than 300% of the Federal Poverty Level (FPL) may apply for assistance with employer-sponsored insurance (ESI) premiums
– ESI plans must offer comprehensive benefits in order for the individual to receive premium assistance
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• Catamount Health
– A non-group insurance product for uninsured Vermont residents with comprehensive benefits
– Offered as a Preferred Provider Organization (PPO) Plan by private insurers beginning October 1, 2007
– Individuals may choose which insurer they would like to use
– If income is between 150% FPL and 300% FPL, then receive state premium assistance
– If income is greater than 300% FPL, then pay entire premium
*300% of FPL is $30,630 for one person and $61,950 for a family of four
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• Chronic Disease Management and Wellness Initiatives
– Comprehensive chronic disease management and wellness initiatives
– Apply to both private and public sectors– Use financial incentives for providers and
individual consumers
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FinancingFinancing- Increase in tobacco tax by 60 cents per pack- Federal matching of Medicaid dollars- State General Fund appropriations- Employers pay a fee based on number of
uninsured employees- Catamount Health Plan: Individuals pay sliding
scale premiums based on income
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Figure 3: Increases in Enrollment in First 6 Figure 3: Increases in Enrollment in First 6 Months (11/07 - 4/08) Months (11/07 - 4/08)
554
252
3187
224
1821
0
500
1000
1500
2000
2500
3000
3500
Medicaid w/oESI
Medicaid w/ESI ESI CatamountHealth w/Premium
Assistance
CatamountHealth w/oPremium
Assistance
Implementation Status
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Figure 4: Projected v. Actual Enrollment Figure 4: Projected v. Actual Enrollment (through 4/30/08)(through 4/30/08)
2535
5655
315
1011
244
3507
273
589
0 1000 2000 3000 4000 5000 6000
Catamount Health w/o PremiumAssistance
Catamount Health w/ PremiumAssistance
ESI
Medicaid w/ ESI
Projected Actual
1122
– Mixed incentives for Medicaid expansion• Adequacy of Medicaid enrollment “carrots”
– Achieving voluntary buy-in to costly plan (Catamount Health)
– Federal financial participation – Complexity of implementing system
change
Implementation Challenges
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Lessons for State Lessons for State and National Reformand National Reform
• Vermont combines coverage expansion with cost control and health programs
• Combination broadens public support for health reform generally
• Public health and disease management gain new traction
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Contacts Contacts
Jim Maxwell, PhDJim Maxwell, PhDDirector of Health Policy & Management ResearchDirector of Health Policy & Management Research
JSI Research & Training Institute, Inc. JSI Research & Training Institute, Inc. [email protected]@jsi.com
617-482-9485617-482-9485
Herbert W. Olson, JDHerbert W. Olson, JDGeneral CounselGeneral Counsel
Vermont Department of Banking, InsuranceVermont Department of Banking, InsuranceSecurities and Health Care AdministrationSecurities and Health Care Administration
[email protected]@bishca.state.vt.us802-828-1316802-828-1316