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Vermont Moves Toward Universal Coverage

Vermont's governor recently signed a compromise bill designed to move the state toward universal coverage and promote chronic care management. The Health Care Affordability Act (H 861) establishes subsidies for uninsured low-income Vermonters to purchase private health plans. Premium assistance will be available to low-wage workers who have access to employer-sponsored health insurance. And for those without access to work-based coverage, the Act creates "Catamount Health" plans. Sold by private carriers, these plans will offer a standard, comprehensive benefit package including primary care, acute and chronic care, hospital care, and other services to be determined by the state. [1] There will be no patient cost-sharing for preventive or chronic care services. Individuals with income up to 300 percent of the federal poverty level (FPL) will receive premium subsidies based on a sliding scale tied to income, and those with higher income will pay the full cost.

The public subsidies will be financed through fees assessed on employers for workers who are not offered coverage or are uninsured, an increase in tobacco taxes, and federal funds through a planned amendment to its Medicaid waiver. The assessment on employers, which will begin April 1, 2007, is $365 per full-time uninsured employee. [2] The state expects approximately 25,000 of the 60,000 uninsured Vermonters to enroll in Catamount Health.

The Act also establishes a number of quality improvement initiatives. Through public–private collaboration, the state will develop a system to manage chronic care conditions for individuals in public and private health plans. Other strategies include collection of health care data from all payers, adoption of rules to publicly report price and quality information, simplification of forms and procedures, and promotion of healthy behaviors through community health and wellness programs.

[1] If private insurers do not voluntarily offer Catamount Health, the state will mandate that they offer the product.
[2] Assessments on part-time workers are adjusted according to actual hours worked. In 2007 and 2008, the first eight full time equivalent workers are excluded from the calculation of the assessment; this exemption is reduced to six in 2009 and four in 2010. The assessment will increase at the same rate as premium increases in Catamount Health.

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