If you live in Vermont – or you’re considering living there – you’ve probably heard about the state’s all-in approach to healthcare reform. More than any other state, Vermont is going above and beyond with ACA implementation, requiring all individual policies to be purchased through the exchange and planning a transition to a single-payer system in 2017.
But there are plenty of other aspects of overall public health and healthcare reform that might be of interest to you. Here’s a summary of health and healthcare in Vermont:
Vermont health ratings
When it comes to overall health, Vermont is tied with Minnesota for #1 in the nation by The Commonwealth Fund’s Scorecard on State Health System Performance 2015. The state held the same second place spot in 2009 and 2014. The state’s scorecard includes details on how the rankings are determined.
Vermont is also ranked second out of the 50 states in the 2014 edition of America’s Health Rankings; on this scoring system, Hawaii is the only state to top Vermont. The state’s low percentage of uninsured residence and low crime rate are among its biggest strengths. It also has a well-educated population with the 5th highest high school graduation rate in the country.
Despite being ranked above nearly all states, there are still challenges in Vermont: low levels of immunization, which is relatively common in affluent states with a highly educated population, a large disparity in health status among people with different education levels, and a high incidence of binge drinking.
Trust for America’s Health published 2015 Key Health Data About Vermont that includes rankings for the state across a wide variety of specific diseases and health outcome predictors. And this interactive map created by the Robert Wood Johnson Foundation lets you compare health factors and outcomes on a county-by-county basis in Vermont.
Vermont and the Affordable Care Act
In 2010, both of Vermont’s U.S. Senators, Bernie Sanders and Jeff Leahy, voted yes on the Affordable Care Act. In the House, the lone Vermont representative also voted yes. All three are still in congress and still supportive of the health care reform law.
Gov. Peter Shumlin is not only supportive of the ACA, he’s the first governor in the country to actively pursue the clause in the law that allows states to take it one step further and eventually implement a state-based single-payer system. Green Mountain Care was set to begin as early as 2017, but the state abandoned its progress toward a single-payer system at the end of 2014, although it still has its proponents.
In November 2014, Gov. Shumlin defeated Republican Scott Milne by about 2,400 votes. But since neither candidate garnered more than 50 percent of the popular vote, it came down to the state legislature to determine the outcome of the governor’s race. Ultimately, Shumlin retained the governorship for a third two-year term.
For the time being, Vermont has expanded Medicaid under the ACA and is running its own exchange, Vermont Health Connect. Unlike most states, Vermont does not allow policies to be sold outside the exchange, so the exchange has been very successful at enrolling a large percentage of the state’s eligible population – 85 percent by the end of the first open enrollment period.
How did Obamacare help Vermont?
In 2012, about 6.8 percent of Vermont residents did not have health insurance – far lower than the national average and the fourth highest rate in the country. Thirty-six percent of the uninsured population was expected to be eligible for expanded Medicaid or CHIP, and the exchange had signed up 85 percent of its potential private plan enrollees by the end of the first open enrollment period.
The state’s uninsured rate fell 1.5 percentage points to 7.4 from 2013 to 2014. By June 2015, it had dropped to 4.6 percent according to the findings of a Gallup poll. However, another survey found the state’s uninsured rate to be just 3.7 percent. Either way, the Green Mountain State is among the states with the highest number of insured people – only second to Massachusetts. Only 1 percent of Vermont’s children are uninsured – the lowest number in the country.
Vermont enrollment in qualified health plans
Near the end of 2013, the Kaiser Family Foundation estimated that Vermont’s exchange had a potential market of 45,000 residents and that 27,000 of them would qualify for premium subsidies to reduce the cost of their coverage. By mid-April 2014, at the end of the first open enrollment period, almost all of them – 38,048 people – had finalized their qualified health plan selections in the Vermont exchange.
During 2015 open enrollment, there were fewer individuals who selected private plans through Vermont Health Connect. Effectuated private enrollment was 33,306 by June, down slightly from 34,923 in March. Of the remaining enrollees, about 64 percent had plans with advanced premium tax credits and 32 percent received cost-sharing reductions.
However, these first two years involved some technical problems for Vermont’s exchange, which resulted in significant system backlogs. On Oct. 1, 2015, Gov. Shumlin announced that progress had been made along with technology upgrades, and things looked promising for 2016 open enrollment.
Two carriers will sell QHPs through Vermont Health Connect – there are no off-exchange plans in Vermont: Blue Cross Blue Shield of Vermont and MVP Health Care. Delta Dental plans are also available on the exchange.
Vermont’s individual health insurance rates have been the fifth highest in the nation, partly because of the low level of competition in the exchange, and partly because the population is older than average and the state uses community rating, with premiums that are not based on an insured’s age.
For 2016 plans, Vermont regulators approved a 5.5 percent weighted average rate increase for the individual market; the carriers had proposed a weighted average increase of 7.75 percent for the individual market.
Five navigator organizations received grants to fund Vermont’s enrollment assistance process from July 1, 2015, through June 30, 2016.
Vermont Medicaid/CHIP enrollment
Utilizing federal funds to expand Medicaid eligibility to 138 percent of poverty has played a significant role in Obamacare’s success in Vermont. As of mid-April 2014, a total of 41,704 people had enrolled in Medicaid through the Vermont exchange.
By August 2015, Vermont’s average monthly Medicaid enrollment had increased by 25,455 people from before expansion – a 16 percent change.
Eligible applicants can enroll in Medicaid at any time during the year, so that number is continuing to increase, further reducing the state’s uninsured rate.
What is Vermont’s health insurance history?
Before the ACA, Vermont was one of only a handful of states where individual health insurance was not medically underwritten; this had been the case since 1992. That means that medical history was not used to determine eligibility for coverage. In addition to guaranteed issue policies, the state also utilized community rating, so premiums were not higher for older insureds.
Although these are good measures to protect consumers, they are not necessarily beneficial for health insurance carriers looking to make a profit, and the market had destabilized significantly by 2006. The legislature passed a measure in that year that contained a variety of reforms, and the ACA later piggy-backed nicely on what Vermont was already doing.
Because Vermont had a law that required all policies to be guaranteed issue, there was no need for a state-run high-risk pool prior to the ACA, but the law did still provide PCIP coverage in Vermont starting in 2010.
Medicare enrollment in the state of Vermont
Vermont Medicare enrollment reached 130,581 in 2015, which is about 21 percent of its population. About 17 percent of the U.S. population is enrolled in Medicare. Historically, 80 percent have qualified based on age and 20 percent due to disability.
Medicare spends about $8,719 annually per enrollee in Vermont. The state ranks 47th in overall Medicare spending with $941 million each year.
Medicare Advantage plans are available to Vermont residents who want additional benefits. These plans are selected instead of Original Medicare, and about 7.6 percent of Vermont Medicare enrollees choose Medicare Advantage over a traditional plan – far below the 32 percent of Medicare beneficiaries who make that choice on a national scale. Vermont Medicare recipients can also select Medicare Part D plans and about 65 percent do, compared with 43 percent nationwide.
State-based health reform legislation
Vermont’s proactive approach to healthcare reform means there is plenty of healthcare-related legislative action in the state. Here’s a summary of recent Vermont bills: