Vermont Workers' Center Fighting for Workers' Rights!

Much focus has been on containing costs and continuing to take testimony on the Douglas budget that is devastating much of the Human Service programs. A major area of focus on cost containment is getting hospital costs under control by moving to a global budget for hospitals. It is in all the bills that have been introduced. This week, the committees invited a Massachusetts expert to come and talk about what they are doing...Massacusetts now has 97% coverage as they have mandated everyone have insurance but they now have the highest per capita cost in the world and that is because they have stayed with the free market based financing. See below for highlights of her testimony which she ended by saying that you cannot do global budgeting of hospitals alone..it won't work.

Several other hearings were also worth noting. See below for highlights of these.

House Health Care Committee
Rep. John Morley, Orleans, absent
Rep. Mary Morrissey, Bennington out of room

Bishca's 2009 Vermont Household Health Insurance Survey.
Staff of Bishca reported on the Survey which is done annually. (can find full report and related info at www.bischa.state.vt.us/health-care/research data-reports/vermont-households-health-insurance-survey-vhhis. People's team has a hard copy)

Highlights of report:
> Number of uninsured did not change from 2008. (43,800)
> Majority of uninsured reside in households whose income is less than 200% of FPL.
> Cost is the main reason uninsured Vermonters lack health insurance coverage.
> Among the uninsured with some type of coverage during the prior 12 months, the majority were previously covered by private health insurance through employment.
> Catamount is counted as a private insurance.
> Movement from private to Medicare is increasing as population is growing older. Vermont has one of highest percentages of people over 45...so will see many cycling into Medicare. But 7 to 8 thousand of those on Medicare are also on other plans due to older population needing to continue to work...
> Approximately 3,600 Vermont children currently have no health insurance. Nearly nine in ten (86% uninsured children live in families with one or more employed parents.
> 80% of uninsured children are eligible for programs but not enrolled
> Approximately 43,800 Vermont adults aged 18 to 64 currently have no health insurance.
>Uninsured adults are more likely to have not received needed medical care, mental health care, or dental care due to cost.
> The % of uninsured adults not receiving needed care,(foregoing care) has increased significantly since 2008.
> More than 4 in ten (43.5% uninsured adults had difficulty paying medical bills and more than one-third(35.3 % had been contacted by collection agencies for unpaid medical bills.
> Vermonters covered by private health insurance decreased by 25,000 in 2009. 10,000 enrolled in Catamount, 9,584 enrolled in Medicaid, 5,071 in VHAP and 968 in Dr. Dynasuar.
> Among working respondents, more than two out of three employers offer health insurance to employees.
> Cost remains the primary and significant barrier to enrolling in ESI ( Employer Sponsored Insurance) among uninsured adults. Those not taking the ESI because of cost has risen from 29.6% in 2008 to 45.9% in 2009. (Bischa does have data on underinsured. high deductible plans and out of pocket expenses but not included in this report)
> Approximately 23,200 of uninsured adults are eligible for State Health Insurance. Nearly two thirds are employed and 62.1% work full time.

Joint session of Senate Health and Welfare and House Health Committee
VWC People Team there. Also there:
Blue Cross Rep
MVP
Cigna
Hospital lobbyists
Bischa folks.

Various bills introduced by various senators: ( Walkthroughs of a group of bills in H Health Care: H.508, 526, 529, 530, 531, 548, 617, 627, 657, 658, 659, 669,674)

Bill to require health insurance companies to cover mastectomy's. Insurance companies do not always cover them. Story told via e-mail, read by rep introducing bill (Franklin was her last name and I forget her first name. My voice recorder died) of elderly woman thrown out of hospital after one of these procedures after the surgery. General discussion over surgical procedures. Till, O'Brien, and Kristy (forget her last name right now) work in the medical field. Poirer asked "why do we put people through this?" Said that if we keep building up pressure on the system and that under a universal system this would be automatically covered.

Bone Marrow donor bill, Jeff Wilson, Manchester, extending parental coverage for kids up to at least 27. Wilson (think he's a democrat), said that 37 states already do this, for kids at home and college enrollees, and whatnot. Bill allows for transition from teenage years to adulthood. Mair told how his son bounces from Vhap to Catamount and back again, depending on the various jobs, so he knows how that works. Poirier commented that no one is counting out exactly what the costs are. Wilson said that Catamount is doing a wonderful job and I wanted to ask him about the bill I had to fight Catamount for this morning in the system which, to him, was so wonderful. Then he said that they may have to raise premiums for Catamount. I forget which committee Wilson is on -- Commerce, I think.

Robin led a discussion on the Massachusetts experiment. Mass. set up health exchange, called it a connector, to list a menu of available policies and their prices. Robin said that Mass. mandated that everyone is required to have health insurance. This was enforced through the tax system. Everyone not on medicare, medicaid, or other employer-sponsored insurance, covered under mass system.

Catamount Fund and Other Related Health Care Issues :

Presentation by Steve Kappel, Consultant, Health Care Reform Commission:
Gave a report on enrollment in Catamount. (handout entitled " Preliminary Analysis of
Catamount Health Premium Assistance Enrollment" Center for Health Policy,Planning, and Research/U.N.E. funding from SHARE/RWJ Foundation.) People's team has hard copy)

John Morley, Orleans, Absent
Mary Morissey, Bennington in and out

Steve Kappel tracked the enrollment change in Catamount from Nov. 07 to Sept.09 in terms of newly enrolled and drop-offs, the duration of coverage and the interactions with other state programs. He used data provided by OVHA.(Office of Vermont Health Access)

Highlights:

> About 16,000 different people have enrolled. About 8,500 are on currently.

> 60% of people who enrolled, drop off. ( did not show why people dropped off) While most people who drop off do not return, about 1,500 had have two distinct episodes of coverage and over 100 have had three or more. Of those who enroll in a given month , between 4% and 8% drop off in each subsequent month until month 12. At that point, about 40% of the original remain and maintain coverage.

> 45% come directly onto Catamount, while a significant % come on from other state programs, particularly VHAP ( about 28%)

> Level of volatility and high administrative involvement due to people transitioning in and out of programs (see visual colored chart in handout) are major concerns. What does each transition cost to consumer, provider, administrator.

Thursday at 2:00 PM Joint meeting of the Senate Health and Welfare Commmittee and the House Health Committee.

Rep. John Morley, Orleans absent
Rep. Mary Morrissey, Bennington left at 2:15 and back at 3:15
Sen. Kevin Mullin, left meeting early on and did not return.

Anya Radner Wallack,Executive Director of the Massachusetts Medicaid Policy Institute, gave presentation on Health Care Cost Control and Payment Reform in Massachusetts. ( Gave several handouts, 1. "Health Care Cost Control and Payment Reform in Massachusetts" 2."Global Payments to Improve Quality and Efficiency in Medicaid:Concepts and Considerations") We have hard copies of these handouts but also can connect with Anya anya.wallack@bcbsma.com until 2/12/10 and at anyarader@aol.com, after that.

Highlights of presentation:

> Massachusetts has probably one of the highest health care expenditures per capita in the US. ( And a just released report by the Ma. Attorney Generals offices finds that it is not because of the number of tests ordered or usage or better quality but rather it is the fact that "Massachusetts insurance companies pay some hospitals and doctors twice as much money as others for essentially the same patient care, according to a preliminary report by Attorney General Martha Coakley. It points to the market clout of the best-paid providers as a main driver of the state's spiraling health care costs." :http://www.boston.com/news/health/articles/2010/01/29/attorney_general_says_clout_drives_up_health_costs/ )

> Have had a global payment pilot program approved and authorized in budget for 3 years but have not implemented. ( said they have found that it is hard to do without having appropriate incentives for provider

> Special Commission set up to deal with Health Care payment and costs. Recommend that global payments become the predominant form of payment to providers in Massachusetts within 5 years. Details have yet to be worked out. Providers will not be rewarded for delivering more care, but for delivering the right care.( one of the legislators asked has anyone defined what is the right care.)

> Also created a Health Care Quality and Cost Council that created a roadmap to Cost Containment: They recommend comprehensive payment reform that encourages global payments as major model for health care payments.

> Anya was asked if starting with global budgeting with hospitals would be a first step and she answered no that would not work, needed to be a global budgeting for all providers.)