Vermont Health Care Reform

Transcription

1 Vermnt Health Care Refrm Hw it will affect yur business, and yur emplyees? Dr. Hsai, H202 (S057) Presented by: Tm Scull, Partner The Richards Grup

2 A Few Initial Observatins The Gal f Federal Health Refrm Acts (Passed March 23 rd, 2010) Have almst all U.S citizens and legal immigrants cvered by health insurance (Universal Health Cverage Mandate). Individuals nt cvered by Medicare r Medicaid will be required t btain health cverage r pay penalties 2014 Emplyer spnsred cverage generally satisfies this requirement There will be health care exchanges run by individual states fr individuals t purchase required health cverage D nt be fled, PPACA is VERY gd fr Big Pharma and Insurance

3 A Few Initial Observatins Gals f Shumlin Bill (t be passed Spring 2011) "The creatin f a single-payer health care system t prvide affrdable, high-quality health care cverage t all Vermnters and t include federal funds t the maximum extent allwable under federal law and waivers frm federal law."

4 A Few Initial Observatins Gals f Shumlin Bill cntinued (t be passed Spring 2011) Cntrl health care csts Meet PPACA requirements fr health insurance exchange t get federal mney Lay fundatin fr single payer exchange Make a clear cmmitment t multi-year refrms that will lead t a real single payer N funding specified: T be prpsed by administratin January, 2013

5 Vermnt's Path t Refrm Hward Dean's Dr. Dynasaur - "universal health care fr children Health Care Authrity created t prpse single payer plan, but it cllapsed in 1995, with Dean ppsing single payer advcates. Many Private Insurers Leave State, 2 left Medicaid waiver creates VHAP, expanding eligibility t medicaid State replaces BCBS with CIGNA (fr prfit) fr State Health Plan Gvernr Duglas elected 2002 MVP Healthcare becmes a significant market in VT CIGNA Picks up almst 30% market share Gvernr vetes publicly-funded Green Muntain Health fr uninsured, t be expanded t universal cverage Catamunt Health - subsidized private insurance (MVP and BCBS) Blueprint fr Health - chrnic care crdinatin thrugh primary care Act 128 passed - Cnsultant study and legislative actin begins Gvernr Shumlin Elected 2011

6 Fall 2010 Act 128 Passed Hired Dr. Hsai as a Cnsultant t prpse at least three design ptins fr creating a single system f health care which ensures all Vermnters access t affrdable, quality health services and his prpsal included 3 ptins: (1) Gvernment-administered and publicly-financed single-payer health benefits system. (2) Allw individuals the chice f private insurance r a public ptin (3) A third ptin designed by the cnsultant, accrding t the principles in Sec. 2 f this act. Sufficient detail t allw the Gvernr and the General Assembly t adpt ne design in 2011, and t begin implementatin by July 1, 2012.

7 Dr. Hsai s Recmmendatin Publicly-financed, privately-administered (by stakehlder bard) single plan with essential benefits (87% value medical, 77% value Rx) Mst likely t be acceptable t majr stakehlders, will prduce mst savings, shuld rely n market when pssible, minimize plitical interference, gain transparency and accuntability

8 Csts and Savings Additinal Csts fr Essential Benefits Cvering the uninsured and prly-insured 5 % Adding primary care and cmmunity hspitals 1 % Dental and visin benefits 2 % Ttal New Cst 8% Savings Reduced insurer & prvider administratin -8 % Reduced fraud and waste -5 %* Integrated delivery system (ACOs) -10 %* N-fault malpractice system -2 %* * Highly uncertain! Ttal Savings -13 t -25* % Net Savings -5 t -17*%

9 Revenue Requirements (Payrll Tax, fr Illustrative Purpses) Emplyer Cntributin Emplyee Cntributin* Essential Benefits Cmprehensive Benefits 9.4% 13.6% 3.1% 4.6% Ttal 12.5% 18.2% * Excludes wages belw 200% f Federal pverty level

10 Reality Vermnt s Path 1. H202 is in Senate Health and Welfare nw they plan t vte it ut Friday 2. It will then g t Senate Gvernment Operatins fr a day r tw 3. Then it will g t Senate Finance fr review 3-4 days 4. Then t Senate Apprpriatins fr 1-2 day cnsideratin 5. It is suppsed t be n the flr f the Senate the week f April 18th. 6. Senate flr, 2 readings n tw different days Amendments prpsed 7. Back t the Huse t a Cmmittee f Cnference, 3 members frm each bdy will be appinted 2 demcrats and 1 republican. They will meet (in an pen public meeting) and wrk ut the differences between the Huse and Senate versin. 8. Once the mutually agreed upn versin is set, it will be vted in an up r dwn vte nly by each bdy n further amendments. 9. This will all have t happen by adjurnment, which right nw is expected t be the first week f May.

11 1st Step: VT Health Refrm Bard Payment refrm/cst cntrl ( ) 5-persn bard emplyed by state: chair, health plicy expert, practicing physician, representative f hspitals, emplyers, cnsumers. Wrk tward cnsistent prvider reimbursement acrss all payers, glbal budgets, unifrm payments methds Develp and apprve payment refrm pilt prjects Establish cst-cntainment targets fr each sectr f the health care system. ensure reasnable payments t health care prfessinals that the amunt paid t health care prfessinals is sufficient and distributed equitably

12 2 nd Step: Vermnt Health Benefit Exchange Facilitate the purchase f insurance frm qualified health plans while prviding a means f mving tward a single-payer system ( ) 2013 Debate, prpse and pass a Financing mechanism 2014: All (nt just uninsured!) individuals and small (< 100) emplyers, state and lcal gvernment emplyees, Medicaid and Medicare recipients Self-insured emplyers ptentially can chse t stay utside the exchange because f ERISA if available Wuld ffer Medicaid and Medicare benefits as well as private insurance (if waiver btained) Cllect all premium payments, administer all benefits Unified, simplified claims administratin and billing, cmmn payment methds and levels

13 3 rd Step: Green Muntain Care 2017 r 2014 (Implemented upn receipt f PPACA waiver ) All Vermnt residents eligible t enrll Private insurers prhibited frm selling cverage that is included under Green Muntain Care May be administered by private insurance carrier Will seek waiver t administer Medicare and Medicaid with Green Muntain Care as secndary/medigap carrier. Budget set each year by legislature Cst sharing (c-pays) set each year by Vermnt Health Refrm Bard, waived fr primary and preventive care, chrnic care management. Run by Dept. f Vermnt Health Access, with Cnsumer and Health Care Prfessinal Advisry Bard.

14 Unanswered Questin #1 by Businesses Why is the financing prpsal being delayed 2 years? A payrll tax? Using a payrll tax as the way f financing the system raises significant equity issues. Thse wh wrk wuld, alng with Vermnt s businesses, shulder the entire financial burden t supprt the system % Payrll tax versus what tday? Incme Tax? Cnsumptin Tax?

15 Unanswered Questin #2 by Businesses Payment Refrm (Dr. Hsai uncertain ) 85% f the healthcare spend is hspital, Prvider and pharmacy cst rising at 8-11% annually Bending this curve is a tugh pill t swallw Private Insurers and Business have tried fr 20 years with significant financial reward t cntrl csts partially successful by emplyer

16 Unanswered Questin #3 by Businesses What happens if is des nt wrk? Vermnt has nly 3 Insurance Cmpanies tday If the Insurance Cmpanies cannt participate n the exchange r sell utside the exchange will they maintain a netwrk in Vermnt? What happens t ERISA prtected Self-Funded Emplyers?

17 Other Questins Essential Benefits f Green Muntain plan? Minimum Silver? Gld? Cverage ut f netwrk? DHMC? Albany? Bstn? New Yrk? Supplemental Insurance availability? Dental Insurance and Visin Insurance why? And it ges n and n

18 Unintended Cnsequences The effect n businesses? The effect n Prviders? The effect n ur Hspital cmmunities?

19 Update frm Washingtn, DC Repeal Entire PPACA Act? Unlikely! Prvisins with the mst imprtance t legislatrs. Individual Mandate Allwing fr subsidies bth in and ut f Exchanges. Exchanges appear t be here t stay

20 Cnclusins Universal cverage is feasible, but fr Vermnt n it s wn path? Achieving it will require vercming numerus significant plitical, financial, and rganizatin hurdles between nw and 2017 Thank yu. Questins?