Vermont State Health Policy - Term Paper Example

Vermont State Health Policy Abstract Under, Unified Green Mountain Care every Vermonter will be having an insurance coverage and it will be financed through one of the proposed financing plans which will fund the system. A full waiver has been granted to Vermont from Obmacare, and Vermont will start their “single payer” system in the year 2017. The Vermont’s governor Shumlin conceived the single -payer system, and he promised all the 620,000 Vermonters with a gift of $3,225 each and every year to pay for free health care by Vermont State. Single-payer system will bear the entire cost of insurance coverage of 620000 Vermonters and thus will result in reduction in inequalities in social determinants and risk factors that ultimately affect health such as clean water, housing, information infrastructure. Single-payment will be funded from tax collections, diversion of financial aids from Federal governments and hence, it will be based on equitable financing and 100% of health care of Vermonters will be met by Vermont State. The Vermont’s governor Shumlin conceived the single -payer system, and he promised all the 620,000 Vermonters with a gift of $3,225 each and every year to pay for free health care by Vermont State. However, Shumlin has not come out with his plans how he is going to fund the same. Only time has to tell us whether Shumlin dream project is going to stand as a model for all the remaining states in USA or going to drain out the state’s exchequer’s resources. INTRODUCTION/BACKGROUND ­­­a. Background on state---population/fiscal capacity/general size of public sector/type of tax structure As per Harvard Medical School study, about 45,000 Americans die each year from treatable diseases since they cannot afford to get affordable medical treatment. (News.harvard.edu 2009). As per United States Census Bureau, as of 2013, Vermont population was estimated at 626,011.This indicates a growth of 0.004% as compared to 2010 census. About 67.7 people were residing per sq. mile as of 2013. (Quickfacts.census.gov 2014). Vermont State Aggregate Receipts and Expenses for the year 2013 & 2012 (in million Source- “file:///E:/1059339/2013_CAFR_Financial.pdf” From the following figure, we can understand that Vermont State spent $2210.9 million or $2.2 billion on human services (which includes healthcare expenses also) which is equivalent to 41.8% of the aggregate of the expenses of Vermont during 2013. Human service expenses include health care, food stamps, Child protective and housing services. Source: “file:///E:/1059339/2013_CAFR_Financial.pdf” The above figures are shown as a graph. II. HEALTH CARE REFORM POLICY [OR POLICIES] PAST and PRESENT Different Health Insurance Schemes available at Vermont Medicaid: This offers insurance coverage for kids, adolescents under age 21, pregnant women, caretaker relatives, parents, disabled or blind people and those aged 65 or above. For qualifying under this, the income level should be below the protected income level” (PIL) or below the Federal Poverty Level. (FPL)”. The Vermont Health Access Plan (VHAP): This scheme is available to those adolescents above the age of 18 and older who are not eligible under Medicaid program and those who are having income below 150% of FPL. Dr. Dynasaur: This scheme covers those children under the age of 18 whose family’s income fall below 300% FPL or pregnant women under 200% of FPL. Catamount Health Premium Assistance (CHAP): This is a private health insurance scheme offered in collaboration with the state of Vermont. Those who have income less than 300% FPL will be eligible under this scheme. Employer-Sponsored Insurance (ESI) Premium Assistance: Vermonters who are not eligible for either CHAP or VHAP will be eligible under this, will have to pay monthly premium and will receive wrap-around insurance coverage. Prescription Coverage: Under this, Vermonters who are not insured and those who are enrolled under Medicare may be paid for prescription medicines footed upon disability, income and age. Long-term Care Medicaid Program: This scheme helps Vermonters to pay for long-run care services. Medicare Savings Plan: Under this , Vermonters whose income under specified FPL limits from 100% and 200% per month in paying the premium for either Part A or Part B scheme. (“Agency of Administration, 2013”). Vermont State aggregate spending on health care schemes has soared from $2 billion to $5 billion per annum in the recent years, and it is estimated that the aggregate health care spending is likely to increase to $10 billion per year in the coming decade. In the year 2006, Vermont State introduced a massive health-care reform, which was aimed at to offer global access to coverage, to enhance the performance and the quality of the Vermont’s health care system and to promote wellness and health across the lifespan. Medicaid expansion and Children’s Health Insurance Program (SCHIP) are some examples of Vermont long history of health-care reforms. Dr. Dynasaur is falling under Green Mountain Care, which offers free-health or low-cost health coverage for teenagers, children and pregnant women. Catamount Health is the premium-subsidy program that permits the uninsured to buy accordable health insurance coverage either through the Catamount or through their employers. Apart from Catamount, Vermont State is offering Blueprint for Health, a statewide disease management program and health and wellness programs across lifespan. The Blueprint program emphasizes on establishing a statewide approach for the management of chronic diseases. (Maxwell 2007). Source: “http://www.timashe.com/wp-content/uploads/2012/10/Health-Care-Graph.jpg” In 2005, Vermont received an approval for a Section 1115 Medicaid waiver known as “Global Commitment Waiver” which permitted the State to restructure its Medicaid program and due to this, Vermont became the only one State that had acknowledged to receive a fixed-dollar cap on the Federal funding for its Medicaid program. Thus, under capped funding arrangement, Vermont is to employ Federal Medicaid funds to refinance a wide variety of its own non-Medicaid health schemes and also offers advantages like enhanced cost sharing, to minimize benefits and to cap enrollment for various Medicaid recipients. b. Summarize reform under ACA—Medicaid expansion, exchanges, waivers In 2011-2012, Vermont State health care reform stated its aim to offer a new health insurance scheme that would cover each and every Vermonter will offer a good health benefit package and will have lower administrative costs. “Unified Green Mountain Care” Vermont is trying to introduce a unique health care system which is to offer the health care facilities which will be treated as a right and not a privilege as the costs are restricted by searching efficacies in the system and by spending dollars more economically and wisely, and the above scheme is meant for offering health coverage to the individual and is not linked to employment. The Vermont Act 48 introduced Unified Green Mountain Care, which will employ the Federally made compulsory Health Benefit Exchange facility as a catalyst, but it will be completely a different type of system. The salient features of Act 48 are as follows: To promote the health of Vermonters To minimize the health care costs incurred by Vermont government To improve the quality of the experiences and care of the providers and patients To maintain high quality of health care professionals in Vermont To make simple and rationalize claims and administrative processes to minimize overhead and to increase efficiency. Vermont State also established the Green Mountain Care Board (GMCB), which is now accountable for supervising all health insurance plans and hospital budgets. It is also intending to introduce the universal system that will be introduced in 2017 without dismantling of the Federal Affordable Care Act. However, there are still some critical questions yet to be answered like how Vermont will fund its health plan, whether State would accomplish the anticipated savings, and what would happen when an American state attempts to smuggle a European-style health insurance scheme? If the ACA fails to extend full coverage and not bringing down the cost, then, Vermont’s single-payer system-the Unique Green Mountain Health Care can serve as a model for the other States in the USA (Mcelwee, 2013). “Vermont Health Exchange” From October 1, 2013 onwards, those employers in Vermont with less than 50 employees will have to buy their health insurance plans only through Vermont Health Exchange. The exchange will offer comparison options as regards to various health insurance schemes and its prices. Under exchange, the health insurance schemes are available, mainly from private service providers with good coverage across the board. Further, for those Vermonters who are under the poverty line will receive tax credits and subsidies to assist them to pay their share of health costs. At the start of 2015, the Vermont Administration will formally make a request for a waiver from the Federal Government to establish a universal system in Vermont. Employers in Vermont State with 100 employees’ strength or less have to buy their health insurance schemes in the Health Exchange from 2016 onwards. In the year 2017, Vermont State government is likely to receive a waiver from the Federal Government for implementing Obamacare and all the present health care schemes that is in force presently in Vermont will be combined into one system, which will be managed by one organization the selection of which will be decided through a bidding process. Under this scheme, every Vermonter will be having an insurance coverage and it will be financed through one of the proposed financing plans, which will fund the system. (www.timashe.com). About 9 out of 10 adults in Vermont have some guise of health insurance, and this figure is higher than the rate in the US on the aggregate, and Vermont was the best-performing quarter of all the States in US in 2010. Since 2008, the percentage of adults with health insurance has stayed constant and Vermont adult insured rate is higher than the average US rate. 2008 2009 2010 Vermont % 88.3 88 88.9 US % 80.7 79.4 78.7 Source: “http://www.gmcboard.vermont.gov/dashboard access”" Read More