April 11, 2010
As we begin getting glimpses of the specifics of the federal health care reform,Vermont's legislative staff have been putting together a report on how this will affect Vermont.
The following is an overview of the broad impact of Federal health reform on Vermont using information available at this date. It includes the impact of the Senate Patient Protection and Affordable Care Act (HR3950), the Health Care and Education Reconciliation Act (HR 4872) and the HITECH portion of ARRA passed January 2009.
I. Summary of Major Impacts on Vermont Insurance Coverage
• 350,000 residents currently covered by commercial insurers will have stronger consumer protections including free preventive care and elimination of coverage restrictions due to preexisting conditions and lifetime or annual limits.(phased in starting in 2010)
• 47,000 residents who do not currently have insurance and 14,000 (excluding Catamount) residents who have non-group insurance could get affordable coverage through the health insurance exchange (2014)
• 53,000 residents could qualify for Federal premium tax credits to help them purchase health coverage. The interaction of these tax credits with the existing Catamount Health premium subsidies is still being assessed, but the premiums paid by most low income individuals and families would go down. (2014)
• 92,000 seniors would receive free preventive services under Medicare (2011) and a comprehensive health risk assessment and customized prevention plan (2012).
• Federal outpatient drug coverage for 18,600 seniors with Medicare Part D would be immediately improved by cutting brand-name drug costs in the “doughnut hole” in half and providing a $250 rebate to beneficiaries who reach the coverage gap. (2010)
• 10,500 uninsured young Vermonters under 27 would have the option of being covered under their parents insurance coverage (2010)
• 11,500 small businesses could be helped by a small business tax credit of up to 50% of the amount they pay for employee health benefits which will encourage them to offer health coverage and make premiums more affordable. (2010)
• Limits administration costs in health plans to 15% for large group market and 20% for small group market. (2011)
Delivery system reform
• Blueprint for Health: Medicare would pay for its share of Community Health Teams with the Vermont impact of a statewide program being approximately $4 million/yr.
• Prevention: In addition to improving coverage for preventive services, the bill increases funding for community based wellness and prevention programs by $500 million in FY10, growing to $2 billion in FY 15. Vermont’s estimated share would be $1 million in FY 10 increasing each year to $4 million in FY 15.
• Payment reform: The bill provides for a wide range of pilot programs for reforming payment of providers including programs such as Accountable Care Organizations (2012). Creates an Innovation Center in CMS to test different payment approaches (2011). Creates an independent Medicare Advisory Board to develop binding proposals to reduce cost and improve quality (2014).
• Healthcare workforce development: Health reform will expand and improve programs to increase the number of health care providers, including doctors, nurses, and dentists, especially in rural and other underserved areas. (2010)
• Reduced costs for prescription drugs. Access to reduced price prescription drugs would be expanded through the 340B program for rural health clinics and critical access hospitals.
• Federally qualified health centers: Vermont’s existing network of FQHC’s would be strengthened and potentially expanded due to a major increase in funding and a revision of the criteria for qualifying. (FY 2011)
Health information technology (ARRA HITECH Act)
• Electronic medical records: Medicaid and Medicare will make available major grants to most physicians and hospitals over four years to install and learn how to effectively use Electronic Medical Records.(2012)
• Health information exchange: The state and VITL have already received two grants with a total funding of $13 million over the next four years to assist providers to select, install and use EMR’s and to complete the development of a secure statewide Health Information Exchange. There are good prospects for an additional $15 million grant as a “Beacon Community”
• Modernization of Medicaid and public program IT: 90/10 federal matching funds will be available for the planned modernization of the Medicaid Management Information System, and for the exchange of information across public programs and with a wide range of social service and health care providers.
• Health IT workforce development: The first two grants to support the development of new HIT workforce through community colleges, including an award of $600 K to CCV, have been announced and a broad range of HIT workforce development initiatives are expected.
Resources/links for more information
• Timeline for implementation of key provisions:
• Summary of combined bill with amendments:
• Section by section summary of combined bill and complete text of HR3950 and HR 4872
As details continue to come in and as the Vermont legislature looks to continue progress towards universal coverage in Vermont, I will post these details as they become known.
For more information about the Vermont legislature, please visit my website at;
Rep. Mike Mrowicki
Windham 5 District-Putney, Westminster, Dummerston