Health Care Reform in Massachusetts and Vermont Modern-day microcosms of universal coverage in America Kevin Liaw, MD University of Tennessee, Knoxville

Massachusetts Healthcare Reform Chapter 58; Acts of 2006 Reform mandates that every state resident obtain a minimum level of health care insurance and provides free insurance for poverty level residents –Free insurance for those earning less than 150% of the federal poverty level –Subsidized insurance for those earning up to 300% of the federal poverty level

Massachusetts Healthcare Reform Requires residents to purchase health insurance and imposes fines if not purchased Requires employers with more than 10 full time employees to provide health insurance and imposes fines on employers who do not offer health benefits

Massachusetts Healthcare Reform The Act established an independent public subsidy plan called the “Commonwealth Health Insurance Connector Authority” which acts as a clearinghouse for private insurance plans and payments –Specifically for certain residents who are not working, do not receive insurance through their employer, or those who meet certain financially based eligibility criteria Commonwealth Care is a subsidized insurance plan that was established for certain poverty level residents who did not meet requirements for Medicaid.

Massachusetts Healthcare Reform Outcomes –As of 2010, 98.1% of residents were insured compared to 87.5% in 2006, prior to reform –Individual premiums have fallen as much as 40% in Massachusetts from the addition of healthy individuals into the insurance pool This is in contrast to a 14% rise in individual premiums nationally over the same time-period –The number of people possessing employer-based insurance is unchanged Health care reform seems to not be eroding the private market

Vermont Recently passed Vermont Health Reform Law in 2011: H.202 Act 48 Goals include universal health care with efficient and high quality health care delivery Becomes the first state to lay the groundwork for a single payer system

Vermont: Act 48 Established a Board charged with changing the way the state charges for health care and controlling growth –Aiming to eliminate fee-for-service reimbursement Individuals will likely be charged a sliding scale based on income

Vermont: Act 48 The goal is to have a plan in place to finance this effort by 2013 The goal for full implementation of this reform, to provide health care for all 620,000 residents via a single payer, is 2017 –This will require a federal waiver

Vermont: Act 48 Further reading: –H.202 Act 48H.202 Act 48 –Vermont’s Health Care ReformVermont’s Health Care Reform