Vermont Health Care Reform
Posted by benarmstrong on 1/18/2009 1:57:01 PM.
This policy was first proposed by Vermont State Legislature and the Vermont Agency of Administration.
Level of Government: State
Status: Implemented

Abstract
Background:
Vermont’s health care reform package represents a host of legislation, dating from 2006 to 2008, that the Vermont State Legislature passed and Governor Jim Douglas signed. The plan is a product of collaboration among the Vermont state government and corporate health care interests. Vermont is consistently among the healthiest states in the country with one of the lowest rates of uninsured residents.
Purpose:
VT HC Reform seeks to: 1) Improve access to health care coverage for all Vermont residents with a focus on continuing a history of employer-based coverage; 2) Improve the quality of health care available to Vermonters; and 3) “Contain health care costs.”
Plans:
Increase Access
VT HC Reform seeks to increase access to private insurance packages.  The Plan creates a new, comprehensive insurance product, Catamount Health, for uninsured individuals to purchase insurance from private insurers. Catamount Health is offered at reduced premium rates for residents who are ineligible for other subsidized insurance plans.  VT HC Reform incentivizes small businesses to offer their employees insurance: previously, Vermont required small businesses to enroll 75% of their employees in an insurance plan if they wished to offer health care to their workers.  VT HC reform lowers the requirement to 50% of employees. 

The Plan also hopes to increase the availability of affordable plans for low-income uninsured residents.  In addition to Catamount’s subsidy expansion, the Plan offers premium assistance for low-income individuals enrolled in Employer-Sponsored Insurance (ESI) programs.  Premiums for the child and adult Medicaid programs will be reduced by 50% and 35%, respectively.

The Plan allots funds for community outreach programs that seek to enroll low-income residents that are eligible for subsidized health care, but remain uninsured.  Efforts to increase enrollment among the low-income uninsured will include marketing campaigns as well as updated technology platforms that will allow residents to determine their eligibility. 

Improve Quality
VT HC Reform seeks to increase the quality of health among residents, preventing chronic conditions and reliance upon sustained health care services.  Programs to improve wellness include increased access to free immunizations, discounts for “healthy lifestyles,” community health planning, and grants to community programs that promote healthy living.  The Plan directs the Department of Health and related bureaus to promote a healthy environment in restaurants through increased labeling, schools through more nutritious menus, and workplaces through advancing best practices.  Vermont is also investing in preventing chronic conditions. The Vermont Blueprint for Health seeks to increase awareness of how to manage chronic conditions as well as promote prevention measures at the local level.  The state also offers multiple programs to “coordinate” care for chronic conditions in order to lower the costs of treatment.  The Plan allots $100,000 for a grant to investigate the potential of community-based insurance programs.

The plan seeks to increase the quality of care by increasing the availability of information on the health care standards of hospitals and other care agencies.  The plan mandates for hospitals to be graded according to their quality of care.  Hospitals must also make information available about the quality of their health care as well as its cost.  The plan sets forth a host of measures to increase the availability of health care information in order to incentivize an increase in the quality of health care.
 
The plan creates a Statewide Health Information Technology  program that seeks to streamline the process of health care acquisition and delivery through the use of technology. 

Technology can make health care more efficient and less expensive.  The plan seeks to partner with major IT firms in Vermont and develop a fund to finance the project.  The plan directs the computerization of VT medical records on a trial basis.  The plan also offers options for sharing information about patients’ medication history and computerizing the prescription process to increase accuracy and efficiency. 
Resources:
The expenses of the VT HC Reform package include increased subsidies and reimbursement payments through funds, costs of research and outreach, and other measures. The VT state government plans to pay for its allocations with an increased cigarette taxes, a nominal tax on health care transactions (<1%) to fund the digitization of health care information, and the penalization of employers according to the number of employees left uninsured. Consolidated Medicaid funding to the state will also be deployed to fund the plan.

Policy Details

The Vermont Plan does not mandate its residents to obtain health insurance.  The Plan proposes measures to make health insurance accessible to all citizens.  If over 96% of Vermont residents have health insurance by 2010, the measures will be considered a success.  If not, the plan requires that the State Legislature consider implementing a “health care requirement” in 2011.

The Vermont Plan seeks to develop community-based health care services.  The plan proposes creating Community Wellness and Health Living Plans that outline preventive care programs on the local level.  Community Care Teams will develop plans for action within each locality.  The Vermont Plan offers grants to Coordinated Health Activity, Motivation and Prevention Programs (CHAMPPS) that pursue goals for community health care.  These measures seek to localize Vermont health care in order to advance preventive health care.

The plan does not offer direct measures to reduce costs by pooling risk, but does propose to investigate merging insurance markets in the future.  The plan also proposes a non-group market security trust in order to reduce premium costs for non-group members seeking health insurance.  However, the state legislature has yet to allocate funds for the trust.

The Vermont Plan shifts the state’s health care focus toward preventive care services and wellness.  The Plan provides for free immunizations at all ages.  It also offers discounts on premiums (Healthy Lifestyles Insurance Discounts) for Vermonters who participate in preventive care and wellness programs.  It seeks to advance nutrition guidelines in schools and eliminate all trans fats from Vermont restaurants.  The plan organizes a working group to investigate remedies for obesity and other weight issues.  The Vermont state government’s Catamount Health Plan will also cover preventive care.  Community health programs, too, will supplement the work of preventive programs.

The Vermont Plan subsidizes individuals with income up to and including 300% of the Federal Poverty Level (FPL).  Medicaid covers families and individuals up to 200% o the FPL and the state government subsidizes those earning between 200% and 300% of the FPL.  The plan, through the state’s Medicaid program, covers children in families with income under 300% of the FPL.  The plan promotes the Vermont Health Access Plan, which covers all residents with income under 150% of the FPL.

Related Links
Vermont Health Care Overview: This primary document from the Vermont State government provides a strong, readable outline of the Vermont health care policy.

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