This is breaking, and significant news. How this plays over the next few days could go a long way to determine which party has the upper hand in local elections this year.
Whether the Governor vetoes it or not, this will be a controversial piece of legislation. Single-payer advocates such as Deb Richter are opposed to any non-radical fix as they fear it will continue to prop up a bad system and soften public support for a drastic overhaul. They fear it will negatively impact future hopes for more systemic reform.
While I can’t help but sympathize with this fear as a gung ho single-payer advocate myself, for my part I see a bill that — warts and all — will help many people, and I am loathe to make “strategic” long-term decisions that eschew bringing needed help to some now in the hopes that it will lead to bringing help to everyone later. That strikes me as dangerously close to offering up those this bill will help now as “acceptable casualties” in the quest for a more comprehensive solution. As such, I therefore encourage folks to call the Governor’s office in support. I realize by taking this stance, I (and others like me) take on an added burden of responsibility to push for a true systemic overhaul over the coming years if this bill passes, as Richter’s concerns (particularly about the long-term financial viability of the proposal) are very serious.
I am also concerned that the long-term viability of health care as an issue (at least for the next 4-6 years) may rise and fall on at least the appearence of progress on the issue. And I take the legislators on their word that this is only the beginning. This is from the summation on the press release I received from the Speaker’s office:
This is the beginning, not the end, of health care reform in Vermont. It sets a foundation for future reforms. We remain determined to make health care progress that moves us steadily toward affordable health care for all Vermonters. This bill focuses our first step where costs are greatest the care of Vermonters with chronic conditions and where the need is greatest the uninsured
The full press release contains details on the plan. It is a quite comprehensive piece, and rather than try to sum it at this point, I encourage you to click on the link below and read the whole thing (minus the last paragraph excepted above):
(The) Bill reins in health care costs by offering affordable coverage to uninsured Vermonters and establishing an outstanding chronic care system
Montpelier (VT)-House and Senate conferees have come together to sign the 2006 Health Care Affordability Act, a bill that is a first step toward achieving the goal of quality, affordable health care for all Vermonters. This legislation has one overriding goal: controlling the steeply rising costs of health care. It accomplishes this in two ways: by better managing chronic care and making health care affordable and accessible for all Vermonters.
This bill is the culmination of two years of intense work by the House and Senate. We listened carefully to the concerns and hopes of Vermonters through last year’s public engagement process, and we worked hard to address the concerns of the Douglas administration. The final bill maintains the principles established last year * a commitment to universal access, comprehensive coverage, and a fair system of financing where everybody pays. It builds on these principles by creating Catamount Health and an outstanding system of chronic care management. This is a bill that Governor Douglas should be proud to sign.
THE HEALTH CARE AFFORDABILITY ACT WILL CONTAIN COSTS BY:
MAKING HEALTH INSURANCE AFFORDABLE AND ACCESSIBLE TO THE UNINSURED
* The bill establishes a health insurance program called Catamount Health. Under this plan, everyone who is uninsured for 12 months will have access to – and will help pay for – a comprehensive health insurance package. The benefits will be administered through the private market and premiums will be based on income. Under the plan, everyone pays their fair share through an affordable premium structure. In addition, employers will pay an assessment based on the number of their employees who are uninsured. We estimate that at least 25,000 Vermonters who are now uninsured will obtain health coverage.* Benefits of Catamount Health include:
o Primary care, preventive and chronic care, acute episodic care, and hospital services.
o Reimbursement for medical services equal to ten percent above cost.
o 25,000 estimated to enroll, including new Medicaid enrollment.
o Chronic care management.* The financing of Catamount Health is fair and fiscally responsible.
o Based on the principle that everybody is covered and everybody pays
o Individuals pay sliding scale premiums based on income
o Employers pay an assessment based on the number of their employees (measured as full time equivalents) who are uninsured, exempting the first four FTEs
o Other revenues from increases in tobacco taxes and through matching federal dollars
o State fiscal obligations protected through caps on enrollmentIMPROVING HOW WE DELIVER HEALTH CARE
* H.861 helps deliver the right care at the right time to the most expensive health care consumers * those with chronic conditions. It makes chronic care management available to every Vermonter, whether privately insured, covered under a public program, or currently uninsured. Chronic conditions consume 70 percent of the cost of health care in Vermont. Chronic conditions are what Vermonters worry about most.
* The plan will establish an outstanding system of chronic care management. This system – available to all Vermonters – will provide:
o Early and coordinated screening for chronic conditions like diabetes or asthma.
o Better management of chronic care.
o Emphasis on patient self-management.
o Payment to providers that rewards quality and disease management, not just quantity. The system will reimburse providers for doing what we want them to do for those with chronic conditions — manage their care. For example, calling patients and reminding them to come in for regular check-ups, visiting patients in their home, and doing the necessary follow up.
* Codifying the Vermont “Blueprint for Health” prevention and chronic disease management plan and directs chronic care management in Medicaid and Catamount Health that will save an estimated 5-10 percent in health care costs.
###(if you have formating proplems please let us know)
DETAILS ABOUT THE 2006 HEALTH CARE AFFORDABILITY ACT
Who is eligible for Catamount Health?
* Only uninsured Vermonters are eligible for Catamount Health. An uninsured person is defined as someone who:
Ø Does not qualify for Medicare, Medicaid, VHAP, Dr. Dynasaur
Ø Has not had private or employer-sponsored insurance that includes both hospital and physician services for the last 12 months
§ If a person has only catastrophic coverage for hospital care, for example, s/he is defined as uninsured for purposes of Catamount Health and does not need to wait 12 months
Ø Has lost private or employer-sponsored coverage during the last 12 months because of: loss of employment, death of the principal insurance policyholder, divorce or dissolution of a civil union, no longer qualifying as a dependent under the plan of a parent or caretaker relative, no longer qualifying for COBRA, VIPER or other state continuation coverage.
Ø Lost college or university-sponsored health insurance because of graduation, leave of absence or otherwise termination of studies.
* An individual 18 or older who is claimed on a tax return as a dependent of a resident of another state is not eligible for Catamount Health.Why are the enrollment figures not higher? What about requiring that everyone have insurance?
* Catamount Health is voluntary. It offers an affordable and comprehensive benefit plan to every uninsured Vermonter. However, we know that only a portion of uninsured will actually enroll in the plan. Based on data from other states and Dr. Thorpe’s economic modeling, we estimate that approximately 25,000 currently uninsured Vermonters will sign up.
* This bill takes a step-by-step approach to increasing enrollments, preferring to establish a successful track record before adding more people over time.
* A number of possible expansions will be evaluated by January 2009 (18 months after initial implementation), including:
Ø eliminating some or all of the 12-month waiting period
Ø allowing the underinsured to buy into the plan
Ø allowing employers to buy into the plan
* Mandatory insurance will be considered if the goal of 96 percent coverage is not achieved by 2010.How is Catamount Health financed?
* The financing of Catamount Health is fair and fiscally responsible and is based on the principle that everybody is covered and everybody pays.
* Individuals pay sliding scale premiums based on income.
* Employers pay an assessment based on the number of their employees who are uninsured, exempting four employees.
* Other new revenues come from increases in tobacco taxes and through matching federal dollars
Ø Increase of $0.60 per pack on July 1, 2006
Ø Increased $0.20 for a total addition of $0.80 per pack on July 1, 2008
Ø Little cigars, roll-your-own tobacco will be taxed as cigarettes
Ø Snuff * changing tax to a per-ounce tax
* State fiscal obligations protected through caps on enrollment.How will the employer assessment work?
* Assessment is on three groups of employees:
o All employees of employers who do not offer insurance to anyone.
o Employees of employers who offer insurance to some employees, but who are not eligible themselves.
o Employees who are eligible for coverage through their employer plans, but choose not to enroll, and are uninsured.
* The assessment is calculated quarterly, and is based on Full Time Equivalents (FTEs). An FTE is an employee who works 40 hours a week for 13 weeks. Employees who work part time, or not for the entire quarter, are converted by dividing their actual hours worked by 520 (40 hours X 13 weeks.)
* The first four FTEs are excluded from the calculation of the assessment. For example, if a firm has 10 FTEs who are not covered coverage, the assessment is based on 6 employee
* The assessment is $365 per FTE in the first year, and will increase at the same rate as the premiums in Catamount Health (estimated at 5% per year).How will the new chronic condition management system work?
* This year’s bill will re-engineer our health care delivery system to better deliver the right care at the right time. More people with diabetes, for example, will receive their eye and extremity exams and fewer will end up blind or with leg amputations. We also will focus more on prevention and early treatment. Dr. Kenneth Thorpe, our health care consultant, estimates that these system changes will result in system-wide savings of $550 million over the next ten years relative to what we would otherwise experience.
* Key to the success of such a system is working closely with primary care providers and paying them to coordinate care for those with chronic conditions. We have to change the focus from treating episodic illness to managing chronic conditions. For example, a successful system will make sure that cancer survivors get the periodic tests they need to make sure their cancer has not recurred.
* The new chronic care model will be available to every Vermonter with any type of health plan, not just to people in Catamount Health and Medicaid.How is a chronic condition defined?
* A chronic condition is defined as an established clinical condition that is expected to last a year or more and that requires ongoing clinical management.
* Examples include: diabetes, hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental illness, hyperlipidemia, and spinal cord injury.What’s wrong with chronic care now?
* Our current health care system was designed decades ago to treat acute health situations. We would go to the doctor only when we were sick and doctors would treat or prescribe or operate, and then send us home. Except for children and pregnant women, our health care system rarely focused on prevention or actively promoting and managing health.
* Approximately 75% of all health care spending today is for people with chronic conditions. In general, our medical system does a poor job with these people. Well documented and accepted national studies indicate that people with chronic conditions receive the right care at the right time only about 55% of the time. These people are suffering for it and we are all paying for it.What about people who currently have insurance? What does this bill do for them?
* People who have insurance currently pay extra in their premiums to cover the health care costs for the uninsured. This bill will begin to reduce this cost shift.
* Through H.861, health care premiums will grow more slowly:
Ø A significantly improved chronic care management program for all Vermonters will reduce spending by $550 million over 10 years.
Ø By covering the uninsured, we will cut into the current 7% added costs that are built into private insurance premiums to cover the health care costs of the uninsured.
Ø Administrative simplifications will save money.
* Reimbursements for hospitals will increase, reducing the effect of the cost shift.How can we be sure savings will pass through to our premiums?
* BISHCA has significant authority to review and approve both hospital budgets and insurance rates.
* H.861 directs BISHCA to set up a task force to report on the best ways to ensure that savings due to reductions in the cost shift will be reflected in hospital budgets and insurance rates.
* Increased payments to doctors are needed to strengthen primary care practices and are not expected to reduce premiums by very much.How will H.861 strengthen primary care?
* We have learned that Vermont’s primary care system is in distress. Doctors are working harder and harder to make ends meet, some regions of the state have shortages, recruitment and retention are problems everywhere, and medical students are choosing specialty areas over primary care.
* Stable and expanded primary care capacity will be needed for chronic care services
* The bill includes several provisions that will strengthen our primary care practices:
Øincreases Medicaid reimbursements for primary care services * increased to Medicare rates
Ø pays in new, innovative, and more appropriate ways for chronic care services
Ø expanded loan repayment program (included in the budget)What about the Medicaid deficit? Will passing this bill make it worse?
* H.861 will not make the looming Medicaid deficit worse. In fact, it will reduce the deficit by:
o Delivering chronic care in a better and more cost-effective manner
o Raising funds for items currently in the Governor’s budget request, such as the Vermont blueprint for health
* All of the state costs related to H.861 will be paid for with new revenues.
* The new “global commitment” Medicaid waiver specifically allows for new federal matching dollars for programs for the uninsured, though a waiver amendment will be required.
* There is sufficient room within the global commitment “cap” to pay for H.861, with about $100 million left over.How is H.861 different from last year’s bill?
* Last year’s health care reform bill set out a staged plan for affordable health care for all Vermonters, focusing in the first step on primary and preventive care for the uninsured. This year, we are offering a bill that covers the uninsured with both in-hospital and out-of-hospital care, a more comprehensive first step than last year’s bill. The bill also establishes a high-quality system for delivering care to all Vermonters with chronic conditions.