Vermont has been a trailblazer when it comes to healthcare reform. The state went 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.
While Vermont now offers off-exchange coverage options and has put its single-payer pursuits on the backburner, it remains a leader in public health, health insurance enrollment, and health reform.
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’s strongest earned its strongest marks in the categories of Access, Equity, and Prevention and Treatment. The state had the second-lowest percentage of uninsured adults and would need to insure only 7,780 more to rise to the level of the best-performing state. It had the third-lowest percentage of adults who went without care because of cost in the past year.
Vermont’s children fared well, too, ranking #1 for the highest percentage nationwide with a medical home and the highest percentage nationwide with a medical and dental preventive care visit in the past year. Vermont’s children also have the lowest hospital admissions for pediatric asthma per 100,000 children.
The state’s scorecard includes additional details on how its ranking was determined.
In the 2015 edition of America’s Health Rankings, Vermont placed second out of the 50 states—Hawaii earned #1. The state ranked first for all determinants and third for lack of health insurance and also access to primary care physicians. The state’s lowest-ranking measure was for its disparity in health status (44th).
Trust for America’s Health published 2016 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. It is worth noting that the percentage of uninsured ranges just 8 to 14 percent across Vermont’s counties, placing it in the 10th percentile. The state’s overall physician to patient ratio is 880:1
How has Obamacare helped VT?
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.
In 2015, with 4.7 percent uninsured, Vermont was one of only nine states that had an uninsured rate below 7 percent. However, another survey found the state’s uninsured rate to be just 3.7 percent. Either way, the Green Mountain State has historically been among the states with the highest number of insured people.
2017 Vermont Health Connect rates and carriers
Vermont’s state-based health insurance exchange was once the only game option for those buying their own coverage. The state did not allow off-exchange plans to be sold. However, in 2016, Full-Cost Individual Direct Enrollment, which is essentially an off-exchange market, was created. Vermont residents can now buy qualified health plans (QHPs) directly from Blue Cross Blue Shield of Vermont or MVP. As it is with every state, no subsidies are available when QHPs are purchased through carriers.
Vermont’s exchange combines individual and small group markets — only one of two states that have done so. In 2017, MVP and BCBS of Vermont will offer plans through Vermont Health Connect; their rate increase average 3.7 percent and 7.3 percent, respectively. State regulators approved lower average rate increases than filed by each carrier.
Vermont enrollment in QHPs
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.
Two years later, in April 2016, Vermont Health Connect reported that 28,167 people had enrolled in QHPs through the exchange and another 4,606 had enrolled in QHPs directly through carriers.
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.
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 – 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.
For the time being, Vermont has expanded Medicaid under the ACA and is running its own exchange, Vermont Health Connect. Despite improvements, the exchange continues to experience some IT problems. In 2016, an independent study was commissioned to determine Vermont’s best course of action in the future. Results will be presented to the legislature and governor by January 2017, at which point the state will decide Vermont Health Connect’s future.
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. While Vermont’s uninsured population was already quite low pre-ACA, the state’s average monthly Medicaid enrollment has increased 14 percent from 2013 to 2016.
Nationwide, eligible applicants can enroll in Medicaid at any time during the year.
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 131,381 in 2015, about 20 percent of its population – the national average is 17 percent. About 82 percent of Vermont Medicare recipients qualify based on age, while the remainder are eligible due to disability.
Medicare spends about $6,903 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 percent of Vermont Medicare enrollees choose Medicare Advantage over a traditional plan – far below the 31 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: