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The Vermont Experience
- 1. SHARE Panel: The Vermont Experience November 5, 2009 Ronald Deprez, Ph.D., MPH The Center for Health Policy, Planning and Research University of New England
- 3. Â
- 9. Affordability-Enrollment 9,648 1,545 31,605 99,600
- 12. Affordability â Measuring Crowd Out
- 13. Affordability â Measuring Crowd Out  ACCOUNTING DECOMPOSITION 2005 2008 Change Public Health Insurance % with public insurance % with public insurance Always Eligible for Public Coverage (05 & 08) 53.3% 59.9% 6.6% Newly Eligible for Public Coverage (08 only) 11.7%  12.4% .7% Never eligible for public coverage  3.5% 3.4% -.1% Private Health Insurance % with private insurance % with private insurance Always Eligible for Public Coverage (05 & 08) 30.4% 26.8% -3.6% Newly Eligible for Public Coverage (08 only) 68.9% 71.8% 2.9% Never eligible for public coverage 91.5% 92.7% 1.2%
- 14. Sustainability â Financial Data
- 15. Sustainability â Financial Data
Hinweis der Redaktion
- Vermont (Catamount Health) For those not eligible for other state/federal programs and without access to ESI PPO plan with comprehensive benefits Preventive care and chronic care covered 100% Premium assistance for individuals below 300% FPL Without premium assistance - $393 per month to enroll Offered by MVP Health Care, Blue Cross/Blue Shield Funded by state revenues, employer tax, Medicaid, premiums ESI Promotes employer coverage by providing premium assistance to individuals under 300% FPL to help pay for employer plan (only if more cost effective than enrolling in state/federal programs) Employer plan must meet requirements (must be comprehensive) Individuals pay no more than they would to enroll in state/federal programs (sliding scale)
- The ability for those in need to purchase the plan Defined by the costs of coverage Measured by plan participation conditioned on estimated uptake/need Need measured by population who go without health care due to cost Need is also defined by proportion uninsured How has implementation compared to what was expected? Outreach has been successful in identifying newly eligible and previously eligible populations Enrollment into new programs (Catamount & ESIA), while less than projected, has shown a steady increase since inception By April 2009, 8,758 people enrolled in Catamount Health More than half of Catamount enrollees have family incomes between 150 and 200% FPL 13.1% of enrollees (1,220 people) have family incomes above 300% FPL and do not receive premium assistance. Catamount has been relatively successful in attracting a younger pop; take-up has been substantially higher than expected among those 35 and over. Enrollment in traditional Medicaid and especially VHAP increased since Catamount program began
- All remaining analyses only include population aged 0 â 64 since they are focus of health reform efforts. Public insurance = All Medicaid, VHAP, Catamount and Medicare (any state or federally subsidized program)
- Trends in health insurance coverage for Vermonters between 2005 and 2008 compared to the region (New England) and national trends No Evidence of crowd-out (migration to public insurance from the privately insured ) Health insurance enrollment increased significantly in Vermont between 2005 and 2008. Public coverage increased due to a combination of newly eligible enrollees (i.e. newly eligible for Catamount) and increased enrollment among previously eligible populations (i.e. previously eligible for other Medicaid programs) Public insurance coverage increased as a result of both increased propensity to get public coverage across all groups and demographic shifts toward eligibility. Private insurance coverage increased as a result of an increased propensity for private coverage, despite demographic shifts that offset this. Crowd-out does not appear to be an issue for Vermont. Similar trends were not observed in New England or U.S. so results may be attributable to HCAA reforms.
- Sustainability = The viability of state insurance reforms to develop secure funding over the long term Biggest single threat to health insurance reforms in states: more insured exacerbate rising health costs When Catamount Health was created, the state chose to create a separate fund to finance it, rather than mixing revenues and expenses into existing funds. Catamount Fund Revenues come from five sources: Incremental revenue from an increase in the stateâs cigarette and tobacco taxes Federal Medicaid funds (matching $$ up to 200%FPL) An assessment on employers who either do not offer insurance to some or all of their employees or who have employees who are eligible for coverage but are uninsured. Beneficiary premiums Interest on the fund balance To evaluate the fiscal sustainability of the Catamount Health Insurance program, we evaluate the fund balance over time and net operating results, both monthly and cumulatively.
- Summary of Findings The fiscal sustainability of the program, as currently funded, does not appear to be sound. If fiscal sustainability is to be achieved, a rebalancing of revenue and expenses will be necessary. Additional data are needed before we can reach a conclusionâespecially given proposed changes at the federal level.
- Medicaid and SCHIP Waivers (Section 1115 of Social Security Act) Federal requirements can be waived for purpose of pilot, experimental projects Expand eligibility to new groups Change benefit package design, higher cost sharing, premium assistance