Rep. Anne Donahue

Legislative Update

November 10, 2007

Those who fear we are moving more and more towards a full time legislature and oppose it (like myself): be on guard. There are more and more regular legislative committees that are meeting on special topics during the “in-between” of a 2-year session in addition to the oversight committees, the study committees, and the special meetings. The increase this year is a significant jump.

While the usual commitments of off-session work by legislators for constituents, in self-education, and in attending meetings and seminars are expected as part of the unpaid portion of a session, full committee meetings are reimbursed. If the time invested is necessary, that is certainly appropriate.

The benefit of these is the opportunity to get more in-depth review work done that can be hard to accomplish with the many interruptions of the regular session. It will certainly make for more informed decision-making. If this meant that the session itself moved more quickly, and stayed in budget, I would defend it. Unfortunately, I highly doubt that outcome.

But thus – more early updates to you.

If it has been a surprise to hear about Green Mountain Care in the advertising campaign of the past few weeks, it may be because you are wondering what happened to Catamount Health.

As our supports for the uninsured increase, the Health Care Reform Committee decided to put all of those options under one umbrella name: Green Mountain Care. It includes the new Catamount Health, along with our four existing health coverage and four prescription assistance plans.

Since Catamount itself has a series of sub-parts based on eligibility categories and on which non-profit insurance plan is offering it, navigating this network would be a formidable obstacle to find the right match. Instead, one website (www.GreenMountainCare.org) and one phone number (1-800-250-8427) connects you to Green Mountain Care, where the “sorting out” of the options for a particular individual takes place.

What is the list of programs Vermont now offers to expand access to health coverage?

Catamount Health is the new plan offered in a collaboration between the state, Blue Cross Blue Shield, and MVP Health Care. Premium assistance is available based upon income, and applies to those who have been uninsured for more than a year (including because they can’t afford health care available at their job)or for specified other reasons.

Medicaid is the traditional low cost or free program for low income children and their parents, those with disabilities, and those over age 65. It sometimes gets confused with Medicare, which is health insurance you pay into with every paycheck, and provides coverage for more limited care, regardless of income, for those over age 65 or disabled. People are “dual-eligible” and can be covered by both if they receive Medicare, but have a low enough income to be eligible for the additional health care coverage Medicaid provides.

Dr. Dynasaur is Vermont’s name for Medicaid that extends to children whose families are in the next income bracket above traditional Medicaid. This is basically the “300 percent above the federal poverty level” program that would loose its federal share of funding if Congress does not revise it to deal with the President’s veto on expansion of the program, by at least maintaining it at the same level: SCHIP (the State Children’s Health Insurance Plan, optional for states to offer) is its official name.

V-HAP (the Vermont Health Access Plan) provides similar help, also on a sliding scale based upon income, to adults who have been uninsured for more than12 months or for other, unpredicted reasons.

It is for adults in the next income bracket above V-HAP that Catamount Health is aimed.

It has three categories:

Catamount Health, Catamount Health Premium Assistance, and Catamount Health Employer-Sponsored Insurance Premium Assistance. It also has a different name based upon the nonprofit insurer offering it: Catamount Blue (from Blue Cross Blue Shield) and MVP Catamount Choice (MVP Health Care.)

If you really want to get confused by names and acronyms, move now to the four other levels of prescription drug assistance based upon low income, disability and age: VPharm, VHAP-Pharmacy, VScript, and Healthy Vermonters.

The reason for the “Green Mountain Care” umbrella name should now be obvious.

But why an advertising blitz (a multi-million dollar one, funded by taxpayers) for all these programs, instead of just the new Catamount expansion?

A primary focus of the 2006 health care initiative was to reduce the number of all uninsured Vermonters, and about half of them are already eligible for our existing programs. Many just didn’t know it. Catamount is only aimed at the smaller portion of the others who earn just a little more, but can’t afford premiums.

The linchpin for income eligibility is the “federal poverty level,”since about everything relates to percentages above that level. What is the poverty level set for 2007? An income of $10,210 per year ($851 a month) for a single person; $20,650 ($1,721 a month) for a family of four; and $27,610 ($2,452) for a family of six.

You would need to contact Green Mountain Care for all the eligibility rules, but roughly speaking, Medicaid is for families under 185 percent of the poverty level as well as with a lack of other types of resources, VHAP mostly extends Medicaid to adults without children up to 150 percent of the poverty level, and Dr. Dynasaur covers children in families up to 300 percent of the poverty level. All have low premiums, tied to income.

Catamount Health now adds premium assistance to uninsured adults without children to that 300 percent level. A single adult earning up to $30,630 ($2,977 per month) would be eligible; the premium paid by the individual would be $392 per month. At between $15,315 ($1,575 monthly) – the VHAP limit – and $20, 420 ($1,702), the individual’s share would be $60 per month.

What is the biggest plus of this health coverage expansion initiative? Steady, reliable access to ongoing health care for those who sign up, rather than resorting to emergency care only when things get bad, and then either being hounded by bills or having costs written off by hospitals to then be passed on to be paid by the premiums that people with coverage and their employers are paying.

How many people are eligible for the new Catamount?

Of the approximately 65,000 uninsured Vermonters, about 7,000 are children (five percent of Vermont children); 79 percent are eligible but not signed up for Dr. Dynasaur or Medicaid, and it’s not clear how many of the remaining 1,470 kids would be eligible for Catamount, since Dr. Dynasaur already goes to the 300 percent of poverty limit of Catamount.

Of the 58,000 adults (10 percent of Vermont adults), about 50 percent are eligible for Medicaid. (Of those, about 43 percent, or 12,470, know they are eligible but are not enrolled.)

Another 20 percent, or 11,600, are above the 300 percent income limit, leaving 17,400 (the remaining 30 percent) currently eligible if they meet the 12 months or other criteria for being uninsured.

What are the risks?

If we get most of those 30,400 eligible under our current Medicaid programs to sign up, our Medicaid deficit will grow, leaving three choice: cuts benefits, raise taxes, or underpay health providers even more than we already do, making much of the difference up through employer and employee health premiums. Hopefully some of that would be offset by preventive care replacing emergency care.

Catamount pays actual costs, so it doesn’t cut the providers short, but it also doesn’t help them fill the cost shift gap. If we get most of those eligible for Catamount to sign up, that target group could pay for itself.

The key is getting healthy, younger people on board and paying premiums. Otherwise, as with any system of insurance, if only those who already realize they need it sign on, it sinks.

The estimates were off enough in terms of the costs and payments projected that between May and August of this year, it totaled out at almost $10 million less than projected in three years. If we do not regain the federal share planned for, but currently being denied, it will be $31 million lees, with $13 million needing to come out of general fund taxes.

The projected reduction of the 10 percent rate of Vermonters who are uninsured has recently been re-estimated from dropping to four percent to dropping to only seven percent.

This continues to look more and more like our education funding crisis. We can try to shuffle around which and whose pocket we take the money from to make it fairer, but that doesn’t change the fundamental problem: the costs.

It’s always interesting to see that when groups or individuals disagree on how to get somewhere, they accuse the other of not wanting to get there at all. Whether it’s health care, education, the environment, or any of the pressing issues that face us, it often isn’t the question of what we want that trips us up: it’s not having consensus on how to solve the problem.

One of the hopes for addressing costs – the effort to streamline paperwork through information technology – is proving to be massively expensive and provoking privacy concerns.

Right now, to better serve our needs and/or desires, there are hospital construction projects in line for state approval that would cost $25 million at Rutland Regional, $19.2 million at Fletcher Allen; $11.5 million at Central Vermont, and $45 million at Southwestern.

The Health Resource Allocation Plan for the state, created by the bill I introduced five years ago and regarded as the foundation for many of the 2006 health reform planning initiatives, has not succeeded in reducing expansion because we are still not willing to say “no”or to be cost-conscious health care consumers.

I just received notice and a request for input now that the first 5-year update process for the plan is getting underway. I suspect I already know what my input will be: More teeth.

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Please share your thoughts and ideas on health care and any other topics of concern that will be facing us in the year ahead. I can be most thoughtful about decisions when I hear divergent views. Contact me any time via counterp@tds.net or 485-6431.