Vermont health insurance

How has Obamacare helped Vermont?

In 2013, about 7.2 percent of Vermont residents did not have health insurance – far lower than the national average and the fourth lowest rate in the country. According to a Kaiser Family Foundation analysis, 36 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.

By 2016, with just 3.7 percent of its population uninsured, Vermont had cut its already-low uninsured rate nearly in half. The uninsured rate crept a little higher in 2017, however, to 4.6 percent (nationwide there was also a slight uptick in the uninsured rate in 2017, after President Trump took office).

While access to coverage has improved and the overall uninsured rate is lower than it was in 2013, Medicaid/CHIP enrollment as of August 2018 was virtually the same as it had been at the end of 2013, before Medicaid expansion took effect, with only about 235 more people enrolled. In other similar-sized states that expanded Medicaid and saw their uninsured population shrink, Medicaid enrollment has grown much more sharply than it has in Vermont.

Medicaid enrollment in Vermont did grow more in the first couple years, and total enrollment was up about 11 percent by mid-2016. But the state has worked to implement accurate eligibility redetermination processes since 2016, to ensure that people are enrolled in the correct coverage. The result has been fewer people enrolled in Medicaid, and more people enrolled in private coverage.

The state merged its individual and small-group markets, which has helped to stabilize the individual market. By June 2018, enrollment in individual plans through the exchange stood at roughly 27,000 people, and about 6,400 more were enrolled in exchange-certified plans purchased directly from the state’s insurers.

Vermont and the Affordable Care Act

Vermont’s Congressional delegation is fully supportive of the ACA. Senators Patrick Leahy and Representative Peter Welch are both Democrats, and although Senator Bernie Sanders is an Independent, he caucuses with the Democrats and has long been in favor of expanding on the ACA with a Medicare for All proposal.

Former Gov. Peter Shumlin was not only supportive of the ACA, he was 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 – though, 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.

But in 2016, with Shumlin term-limited, a new governor was elected. Phil Scott, a Republican, was among a group of nine bipartisan governors who signed a letter in 2017 asking Congress to drop the Graham-Cassidy ACA repeal measure that was then under consideration, and instead focus on bipartisan efforts to stabilize the individual health insurance markets. Scott was re-elected in 2018.

Vermont has expanded Medicaid under the ACA and is running its own exchange, Vermont Health Connect. The state is also piloting an all-payer system that’s focused on efficiency and health outcomes, as opposed to paying providers on a fee-for-service model. And starting in 2020, Vermont will implement an individual mandate, requiring residents to have health insurance or pay a penalty. The ACA includes a mandate, but the associated penalty no longer applies after the end of 2018. Massachusetts already had a mandate, but Vermont, New Jersey, and DC enacted legislation in 2018 to implement their own mandates (effective in 2019 in DC and New Jersey, but not until 2020 in Vermont).

Vermont implemented health care reform well before the ACA

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 (this is still the case; Vermont and New York are the only states where insurers cannot charge older applicants more than they charge younger applicants).

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 143,511 as of September 2018, about 23 percent of its population – the national average is 18 percent. About 84 percent of Vermont Medicare recipients qualify based on age, while the remainder are eligible due to disability.

In 2016, Medicare spent about $7,541 per Original Medicare enrollee in Vermont. The state was one of just eight where average per enrollee spending was under $8,000 (the data is adjusted to account for regional variations in payment rates.

Private Medicare Advantage plans are available as an alternative to Original Medicare, although they are far less popular in Vermont than they are in much of the rest of the country. As of 2018, only about 15,000 enrollees (10 percent of Vermont’s Medicare population) had opted to receive their Medicare benefits from a private insurer instead of Original Medicare. That was far below the 36 percent of Medicare beneficiaries who make that choice on a national scale.

Vermont Medicare recipients can also select stand-alone Medicare Part D prescription drug plans to supplement their Original Medicare coverage and about 65 percent do, compared with 43 percent nationwide. This makes sense, as Part D plans are intended to supplement traditional Medicare (Medicare Advantage plans generally have built-in Part D coverage), so in states where Medicare Advantage enrollment is lower, Part D enrollment is likely to be higher.

Vermont health insurance resources

• Filing an insurance complaint in Vermont

State-based health reform legislation

Vermont’s proactive approach to healthcare reform means there is plenty of healthcare-related legislative action in the state. Scroll to the bottom of this page for a summary of recent Vermont bills.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.