As most Vermonters are aware, in May 2011, the Vermont legislature passed Act 48, a bill that reforms the way Vermont pays for and delivers health care. Act 48 puts Vermont on the path to a single payer system, but leaves many questions to be answered in the future, including how to finance the new system.
Act 48 has three main components:
- Act 48 establishes the powerful, 5-member, Green Mountain Care Board. This board is charged with changing the way Vermont pays for health care and controlling growth in health care costs. The Board will oversee pilot projects, like the Blue Print for Health, that test new models of payment (and delivery) and will work to design a health care budgeting system for the state that assures adequate health care resources and fair pay for providers. In addition, the Board will recommend the benefits package to be provided under a single payer.
- Act 48 requires the Green Mountain Care Board and the Secretary of the Administration to develop a detailed plan for a single payer. Based on the benefits package developed by the Board, the Secretary of Administration will develop a financing plan for universal coverage. The plan will address the likely costs of coverage, potential savings from reforms, and recommended sources of revenue. The Legislature will then vote to approve or disapprove the financing plan. The financing plan is due in 2013, but full implementation of the plan requires a federal waiver, which, under current law, is not available until 2017.
- Act 48 Establishes a Health Benefit Exchange as required by federal law. The creation of the Exchange will bring federal financial benefits, including tax credits, to help make premiums affordable for uninsured Vermonters. The Exchange must be operational for 2014 for families, individuals and small employers and will open to large employers in 2017. The Exchange will offer plans from at least two private insurers plus two multi-state plans required by federal law. The Exchange will simplify health insurance administration and help people comparison shop for health insurance.
Act 48 establishes the framework for health care reform in Vermont but leaves many important questions unanswered. In the coming months, in this blog, we will try to answer some of the following questions.
- Under a single payer system, where insurance is no longer purchased primarily through employment, but rather is a right of residency in Vermont, how will businesses that employ people who are residents of other states be affected? Will those businesses be able to buy insurance for those out of state employees? Similarly, how will Vermont residents who work for employers in other states be affected?
- If a Vermont resident/employee leaves his or her job and moves to another state, will Green Mountain Care offer the option of some kind of COBRA-like coverage?
- How will the Green Mountain Care affect Worker’s Compensation?
- Will dental and vision coverage be included? If not, will employers be able to buy these additional coverages for their employees?
- Will there still be Health Savings Accounts?
- Will employers be able to provide wellness incentives or benefit packages that are “richer” in coverage than the Green Mountain Care plan if they want to?
- Will Vermont lose any money or benefits proposed under the federal Patient Protection and Accountable Care Act by implementing its own health care system, either during transition or when fully implemented?
Stay tuned for the answer to these and many other questions about Vermont’s health care reform.