Showtime: universal healthcare bill unveiled

Here is the bill which will be introduced in the House Healthcare Committee this morning.
The Policy Committee for the Healthcare Is A Human Right Campaign is already hard at work applying our Human Rights Standards (see: Let us know us know what you think.

Here is the outline text:

2011 Governor’s Health Care Reform Legislation



February 8, 2011


1. Control health care costs;
2. Meet minimum federal requirements for establishing a health insurance exchange as a necessary precursor to application for implementation grant;
3. Lay the structural foundation for a “single payer exchange”;
4. Make a clear commitment to multi-year reforms that will create a “real” single payer (includes all Vermonters, is publicly financed and is decoupled from employment).

Three stages of health reform, 2011-2014 (and beyond):

Exchange Single Payer Exchange Single Payer

Building blocks:

* Blueprint for Health (patient-centered medical home)
* Health information technology
* Vermont Health Reform Board
* Vermont Health Benefit Exchange
* Green Mountain Care (single payer)


1. Principles – largely restated from Act 128 (2010) (Sec. 1)

2. Strategic Plan for a Single Payer and Unified Health System (Sec. 2)

* Upon receipt of necessary waivers, all Vermonters are eligible for Green Mountain Care (GMC)
* Includes Medicaid and Medicare, employers who choose to participate, and state and local employees
* Secretary of Administration or designee shall seek all necessary waivers

* Report-backs (See 5. Below)
o Integration plan (Sec. 8)
+ How to fully integrate or align coverage for Medicaid, Medicare, private insurance, state employees, municipal employees in exchange
o Financing plan (Sec. 9)
+ How to finance care for full coverage – through exchange and through GMC -- and other needed initiatives
o Health Information Technology Assessment (Sec. 10)
o Health System Planning, Regulation, Public Health (Sec. 11)
o Payment Reform; Regulatory Process (Sec. 12)
o Workforce Issues (Sec. 13)
o Medical Malpractice Study (Sec. 14)
* Secretary of Administration or designee shall implement following:

o July 1, 2013: exchange enrolls individuals and employer groups <100
o July 1, 2016: exchange enrolls employer groups >100
o January 1, 2014: BISHCA requires that all individual and small group insurance products are sold through the exchange
o January 1, 2014: BISHCA requires all large group health insurance to align with that which is offered in the exchange

3. Cost Control and Payment Reform (Sec. 3)

* Create Vermont Health Reform Board: five members
* Appointed by Governor, six-year terms, chair is paid full-time and others are paid half-time
* Members: expert in health policy; practicing health care professional; hospital rep; health insurance purchaser; consumer rep
* Duties:
* On cost:
o Establish cost containment targets and budgets for each sector of the health care system
o Develop global budget
o Review BISHCA decisions on insurance rates
o Develop and implement payment reform pilots
o Review and approve global budgets and capitated payments
o Review and approve fee-for-service payments
o Provide guidance to exchange re: rates paid to insurers
* On quality:
o Evaluate system-wide performance
* On payment methodologies:
o Eliminate cost shifting
o Negotiate consistent provider reimbursement across payers
o Identify innovative payment methodologies
* On payment reform pilots:

* Develop pilot projects to: manage total health care costs, improve health care outcomes, provide a positive health care experience for patients and providers, align with the Blueprint for Health strategic plan

4. Public-Private Single Payer System (Sec. 4)

Vermont Health Benefit Exchange 33 V.S.A. Chapter 18, Subchapter 1

* Established July 1, 2011, and given the following duties:
o One exchange for individuals and businesses
o Exchange includes small group, up to 100 employees
o Duties include those required by federal law
o Determines eligibility for Medicaid or other state/federal health insurance programs (Sec. 5 & 6 – moves eligibility from DCF to DVHA)
o Negotiates and collects premiums
o Contracts selectively with insurer(s)
o Sets requirements of participation for insurer(s): provider payment, administrative systems, etc. (see QHP requirements below)
o Unless PPACA waiver is obtained, Exchange also provides access to two federal plans
o Input from consumers and health care professionals through an advisory board which replaces the Medicaid Advisory Board (Sec. 7 & 30(a))

Green Mountain Care (single payer) 33 V.S.A. Chapter 18, Subchapter 2

* Established upon receipt of an ACA waiver, and given the following duties:
o Comprehensive coverage for all Vermonters; emphasis on primary care; “smart-card” technology
o Annual budget proposal consistent with VHCRB recommendations
o Green Mountain Care Fund created for pooling funding streams

* Both exchange and GMC incorporate:

o Minimum benefits established by the Vermont Health Reform Board
o Mental health parity
o Additional benefits for Medicaid if necessary
o Provisions for supplemental and retiree benefits
o Blueprint – all must have medical home
o Administrative simplification – shall establish systems for reducing complexity

5. Report-backs

* Integration plan (Sec. 8)
o How to fully integrate or align Medicaid, Medicare, private insurance, state employees, municipal employees in exchange
o Whether to establish Basic Health Plan option to ensure affordable coverage for low-income Vermonters
o Specific changes needed to integrate private insurance and whether to continue to allow associations
o Create a common benefit package in the exchange, including analysis of current insurance mandates and affordability of cost-sharing
* Financing plan (Sec. 9)
o How to finance care for full coverage – through exchange and through GMC -- and other needed initiatives
* Health Information Technology Assessment (Sec. 10)
o Reassess HIT progress in light of new goals
* Health System Planning, Regulation, Public Health (Sec. 11)
o Recommend modifications to unify existing systems engaging in planning, public health and quality
* Payment Reform; Regulatory Process (Sec. 12)
o Reviews current regulation that may apply to payment reform pilots to determine if it is in alignment with goals
* Workforce Issues (Sec. 13)
o How to optimize licensing and scope of practice for current primary care workforce
o Create a plan for workforce retraining to address dislocation due to administrative simplification when Green Mountain Care is implemented
* Medical Malpractice Study (Sec. 14)

6. Immediate Initiatives

* Rate Review (Sec. 15)
o Provides for final review of rate increases by the Vermont Health Reform Board
o Broadens rate review criteria to include affordability, quality, and access
* Employer Health Benefit Information (Sec. 16)
o Requires employers to provide employees with an annual statement of total premium costs for health benefits to inform employees of total premium costs
* Statewide Preferred Drug List (Secs. 17 – 24)
o Directs the Drug Utilization Review Board to create a statewide preferred drug list to be used by Medicaid, insurers, and state and municipal employees
o Allows self-insured employers to elect to use the PDL
o Provides for variants from the PDL for Medicaid where supplemental rebates are cost-effective
o Conforming amendments to existing law establishing Medicaid PDL and rebates
* Repeals the Public Oversight Commissio (Sec. 30(b))
o Reduces administrative burden for certificate of need requests

7. Conforming Amendments to Current Law

* Secretary of Administration (Sec. 25)
o Revises current statute directing Sec. of Administration to coordinate heath reform to reflect new and changed initiatives
* Department of Health (Sec. 26)
o Revised duties to include a state health improvement plan
* VHCURES (Sec. 27)
o Ensures Vermont Health Reform Board has use of VHCURES data
* PPACA Grants (Sec. 28)
o Extends date from July 1, 2011 to July 1, 2014
o Allows agencies to apply for federal grants
* Primary Care Workforce Committee (Sec. 29)
o Allows committee to work for one additional year
o New recommendations due in March 2011
* Effective Dates (Sec. 31)