By Donna Sutton Fay, Vermont Campaign for Health Care Security Education Fund
Vermont has been successful in incrementally expanding its public health insurance programs for the past twenty-five years. Subsidized coverage is available to children and uninsured adults with incomes up to 300% of the FPL. We have one of the lowest rates of uninsured in the country. Approximately156,000 Vermonters are enrolled in a state health insurance programs. Despite these successes, it was clear to most everyone in Vermont that our current system is not sustainable. Health care costs are not being contained. Every legislative session advocates had to work harder to prevent cuts to programs and premium and cost-sharing increases.
Against this backdrop of very popular health care programs, Governor Shumlin campaigned on creating a single payer health care system. It was the cornerstone of his campaign and his priority this legislative session. While certainly not all groups and citizens agree that a single payer system is the answer, all agreed the current system is not sustainable. Those who fought against the Governor’s proposal offered no alternatives. In this environment with a Democratic Legislature, Governor Shumlin made good on his campaign promise and the Vermont Legislature passed H.202, “An Act Relating to a Universal and Unified Health System. H.202 does not create a single payer system but it does put Vermont on the road to a “universal and unified health system”.
H.202 sets in motion the timeline for implementation of Green Mountain Care– comprehensive, affordable, high quality publicly financed health care coverage for all Vermonters by 2017. The legislation outlines the steps that will lead up to Vermont’s request for a federal waiver in 2015 to implement Green Mountain Care in 2017. The Legislature will have to enact a financing plan and appropriate funding, and the Green Mountain Care Board will have to approve the benefit package. The legislation requires that Green Mountain Care’s benefit package cover at least the same services as are covered under our Catamount Health plan. The actuarial value of Green Mountain Care must be at least 87%.
The Health Care Reform Director, a new position in state government, will be appointed by July 1. It will be the director’s job to coordinate the efforts among state government agencies and the new Green Mountain Care Board. The significance of the new director is that state agencies will have to work together, something that has not always happened in the past.
The Green Mountain Care Board is to be appointed by October 2011. The board is the centerpiece of the plan for implementation of the legislation and of Green Mountain Care. It is probably unlike any other similar board in any other state. It is an independent board, consisting of a director and 4 members. The board’s duties are far-reaching, including overseeing the development and implementation of payment and delivery system reforms, setting the benefit package for Green Mountain Care, setting reimbursement rates for health care professionals, and approving hospital budgets. The Governor appoints the Board from names given to him by the nominating committee, which are subject to confirmation by the Senate.
The legislation also sets out the framework for Vermont’s Health Insurance Exchange. Vermont has set up its Exchange in a unique way. It is designed to meet the requirements of the Affordable Care Act. However, unique to Vermont, it also is designed to be the foundation to transition to Green Mountain Care, and cease to exist with approval of the waiver for implementation of Green Mountain Care. The Exchange will be part of the Department of Vermont Health Access, Vermont’s Medicaid Agency. A number of questions remain to be determined next year, such as whether a small business will be defined as either 50 or 100 employees and whether qualified plans will be allowed to be sold outside the Exchange as well as in the Exchange.
Advocates worked hard to insure as much public input as possible in the development of the Exchange, the Green Mountain Care Board, and the development and implementation of Green Mountain Care. The bill establishes several consumer advisory boards. The Green Mountain Care Board must have a “consumer, patient, business and health care professional advisory” board. The Medicaid and Exchange Advisory Committee is established to replace our current Medicaid Advisory Board, to advise the Department of Health Access on issues related to Medicaid programs and the Exchange. The legislature also expanded the authority of the Health Care Ombudsman to analyze and monitor the development and implementation of the activities and policies of the Green Mountain Care Board.
While H.202 creates the foundation for Vermont’s universal and unified system, it also outlines the information the Legislature will need in the next few years to fully design and implement the system. The Legislature has reports due in early 2012 on issues such as: a plan to integrate and align Medicaid, Medicare, private insurance, associations with the Exchange; a draft of qualified health plans with projected premiums that might be available in the Exchange; a comparison of federally-determined essential benefits and benefits mandated by Vermont for coverage; whether qualified health plans should be offered both in and outside of the Exchange; analysis of whether Vermont should offer a Basic Health Program to ensure our current VHAP and Catamount Health enrollees maintain affordable and comprehensive coverage. In January 2013, two financing plans are due. One plan will recommend financing amounts and mechanisms for the Exchange, and one plan will recommend financing and mechanisms for Green Mountain Care.
Stay tuned. While this was a very exciting year for health care reform in Vermont, there is much more work and excitement to come as we continue to work towards the implementation of universal coverage for all Vermonters.
