H.202 House Health Care Amendment
Questions and Answers
Q. Why do we need health care reform?
·        The cost of the status quo is too high is growing at an unsustainable rate—our current system will bankrupt us if we don’t act to control costs.
o       Vermont’s health care costs are rising by $1million per day and are growing 12 times faster than the State’s economy.  Costs have doubled since 2006.  In 2012, health care for Vermont residents will cost nearly $6 billion.
o       Families with private insurance pay an average of $5,000 per year in out-of-pocket healthcare costs, not including premiums. That is unsustainable for Vermont families, business and economy.
o       Studies show that most bankruptcies are caused by health problems and medical bills.
o        More than 47,000 Vermonters are uninsured and as many as another 90,000 are underinsured.  That’s more than one quarter of the state’s population vulnerable to the danger that one major illness could cause them to lose everything.
o       As a result, too many uninsured Vermonters put off seeing the doctor because their out-of-pocket costs are so high. That puts too much reliance on expensive emergency room care, the cost of which ends up being passed to those who have coverage in the form of higher insurance premiums.
o       Vermonters spend almost 20% of their total earnings on health care and the state budget spends almost 25% on health care. The rest of the world spends only 6-12% of national income on health care yet achieves better health outcomes.
·        The system is limiting Vermonters’ control, choice and quality of care.
o       Insurance company bureaucrats deny patients the treatment they need, and insurance companies have free rein to raise Vermonters’ insurance rates without any transparency or accountability.
o       Doctors and hospitals are forced to spend too much time on paperwork at the expense of time on patient care.
·        Vermonters don’t get the most value for their health care dollars.
o       We spend too much on administration and other costs that do nothing to help Vermonters stay healthy.
o       While we spend more than other countries, we do not achieve the same health outcomes as other universal health care systems around the world.
o       We could get more and spend less.

Q. Why is H. 202 the right thing to do?
  • This plan puts the “care” back in “health care.”  It allows health care professional focus on helping patients instead of tracking down payments.
·        The plan provides our best chance to control overall health care cost.  Most Vermonters and employers could pay less.  In fact, in the first year it is implemented (some years out) the plan will save hundreds of millions of dollars. 
·        The new system will be fairer than our current system. It will ensure that all Vermonters have access to essential health benefits including primary care, preventative care, chronic care, acute care, and hospital services.  Everybody pays in and everybody benefits.
·        H.202 is an economic development and job creator.  A universal health care system will create as many as 5,000 new jobs as it reduces costs to businesses, allowing employers to reinvest that cost into growing their businesses.

Q.  What does H.202 do?
H.202 helps control health care costs and improves access to health care by:
·        Creating the health benefit exchange
·        Creating Green Mountain Care, a universal health care system that will provide health care to all Vermont residents.
·        Creates the Green Mountain Care Board to implement cost savings, and negotiate benefits and payments in a universal health care system.

Q. How will the quality of care Vermonters receive be improved?
  • All Vermonters will have access to primary care which will help Vermonters focus on staying healthy and treating minor health problems before they become big problems.
  • Green Mountain Care will ensure that all Vermonters—including children and seniors—have access to the basic care they need to stay healthy and to recover when health problems arise.
  • Many Vermonters will see their benefits package greatly improve, providing them access to primary care, preventative care, chronic care, acute care, and hospital services.
  • Doctors and health care providers will spend less time on bureaucratic paperwork and have more time to spend with their patients

Q. How does H.202 control costs?
The House Health Care amendment controls health care costs in several ways:
·        It will reduce unnecessary administrative costs that don’t contribute to patient care and will maximize our potential to save money through reforming our payment system so we reform health care delivery and pay for quality of care, not quantity of care.
·        By creating a health benefit exchange to create more uniformity in the health insurance markets and by beginning to reduce administrative costs.
·        By increasing public transparency and input in the rate review process by having insurers provide consumers with plain language summaries of rate increases over 5 percent and by giving consumers a way to comment to BISHCA when their insurance rates go up.

Q.  How is the House Health Care Committee version different from the Governor’s proposal?
·        The Green Mountain Care board is more accountable and more independent.  Nominations must be made through a nominating committee similar to the judicial nominating process.
·        The process for moving forward is more clearly defined and has clearer check-ins and approval processes.  A financing plan and Green Mountain Care budget would need to be enacted into law prior to implementation.
·        Public input is required in development of the Green Mountain Care benefit package and financing plan.

Q. Will Vermonters still be able to choose their own doctor?
Yes.  Green Mountain care preserves patient choice of provider.  It also builds on the Blueprint for Health’s emphasis on connecting Vermonters to a primary care doctor.  Vermonters will continue to receive the quality and choice of care they like in the current system.

Q.  How is this good for employers?
Green Mountain Care provides health benefits to all Vermonters – regardless of whether their employer chooses to offer insurance.  It would eliminate the unfair competition between employers who offer health insurance and those who choose not to.  It will also lower the overall costs of health care for Vermonters.  The bill does not tell employers what to do or what they have to offer for benefits.

Q.  Who is eligible?
  • All Vermont residents are eligible for Green Mountain Care. 
  • Residents of neighboring state would not be able to cross the border to get free care.  Any non-resident who receives health services in Vermont would be billed for the care they receive.

Q. How does Green Mountain Care impact…
  •  Retirement benefits? Green Mountain Care does not require employers to change their practices. Vermont retirees would be eligible for Green Mountain Care regardless of whether their employer offers benefits.  Green Mountain Care would be a secondary benefit to any existing retirement benefit.
  •  Medicare?  Medicare benefits are not touched.
  • Union-negotiated benefits? Employers and unions may continue to bargain to offer benefits if they choose to.
  • Medicaid? Medicaid and Dr. Dynasaur benefits will not be changed.  Medicaid will not be able to offer benefits that are lower than Green Mountain Care.
  • When Vermonters are out of state?  Vermont residents will remain eligible when they are temporarily out of state.  The Secretary of Administration is required to look at the following issues for Green Mountain Care and report back to the general assembly January 15, 2012 with recommendations: 
  •  Young adults under age 26 whose parents live in Vermont
  • College students going to school in Vermont 
  •  How to get health care when you are out-of-state
  • What type of out-of-state provider networks are available to Vermonters

Q.  Are we moving too fast?
We will spend an additional $1.6 billion per year by 2015 – we can’t afford to wait.  There is near universal agreement that our system is broken and must be reformed.  H.202 takes the first steps toward a multi-year process of reforming the health care system.  The House Health Care (HHC) committee’s amendment includes check points along the road to reform – this allows the general assembly to make sure reform is headed in the right direction, at the right speed. For example, some of the check points include:
·        Reports to the general assembly for major decisions, such as benefits or payment methodology changes
·        Approval by the general assembly of budgets and financial issues
In addition, this is a multi-year process, starting with an health benefit exchange in 2014 (required by federal law) – which gives individuals and small employers better access to private health insurance plans in an easy to compare format.
Q. Why does H. 202 not include a financing plan?
Done correctly, a reformed health care system will cost less than our current system.  We already have a complicate and inequitable financing system and there is no doubt that we can create a new one that is more fair.
We could develop a financing plan more quickly if we want it to be less accurate and limit opportunity for Vermonters, including employers, to participate in creating it.  To be accurate, a financing plan must be based on accurate information about the benefit package, reimbursement rates, federal participation and other factors.  The House Health Care Committee required the Administration to conduct a public engagement process to include Vermonters in the development of a financing plan.
Q. Why would the federal government give Vermont a waiver from the federal Affordable Car Act (ACA)?

President Obama has already said that he supports states in exploring innovative ways to achieve the goals of the ACA.  Green Mountain Care does this.  It helps control health care costs and improves access to health care.