The Word in the House 3/18/2015 - Health Care after Single-Payer

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 (