Healthcare Reform Essay
Info: 3068 words (12 pages) Nursing Essay
Published: 9th Apr 2021
Healthcare reform in Vermont
Vermont is one of the states of the United States and it is found in the region of New England. New England is on the Northeastern side on the United States. Vermont is the 2nd least populous state in the US, and the 6th least extensive. This is the only state in the New England region that does not have a border with the Atlantic Ocean. However, half of its Western border is found within Lake Champlain, and it shares this border with New York. On the south of Vermont lies Massachusetts, while on the east, there is the state of New Hampshire. On the north of Vermont lies the Canadian province of Quebec, while on its east, there is the state of New York. As of July 2013, the census Bureau of the US gives an estimation that the total population of this state of Vermont stood at 626, 630 people (Abrahamsen, 2012).
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This represented an increase of 0.14%, when compared to the census of 2010. The state of Vermont has an increase in the aging population, and on this basis, there is an increase in the provision of aging health care services within the economy of the state (Abrahamsen, 2012). The Allen Fletcher Health is considered as the biggest private health provider in the state of Vermont, with an employee base of around 7,100 people. As of the year 2010, the entire bill that patients in the hospital paid amounted to 3.76 billion dollars. Currently, 92,000 people have enrolled for the Medicare program. It is important to denote that as of 2011, Medicare was able to spend 740 million dollars on the health care of the state (Deary and sBrown, 2001).
The financial capacity of the state is very stable, and it has been able to achieve a balanced budget, since the year 1991 (Deary and sBrown, 2001). The state has an enterprise fund, for purposes of sponsoring activities that would reduce social and economic problems like unemployment, drug abuse, etc. For purposes of understanding the economic strength of Vermont, the state has an individual’s per capita income of 38,306 dollars.
On the other hand, the general size of the public sector is 24.3%, when compared to that of the private sector which amounts to 36.6% (Abrahamsen, 2012). Based on these grounds, the private sector is wider than the public sector. The tax system of this state is also favorable, and one of the unleast fair tax structure in the United States. This is because the tax structure gives income tax credit to low waged workers. This is for purposes of ensuring that there is an equitable distribution of resources.
Prior Health Reform Policy:
One of the health care reforms initiated by the state of Vermont is the Dynasaur programs. This is a program that is funded by the government of Vermont, and was formed in 1989. This program was aimed at providing universal cover to the children of Vermont, and when this was added up by the private insurance individuals that Vermont had, the state was able to ensure universal health coverage of all its children (Deary and Brown, 2001). Because of this policy, the state of Vermont was able to be regarded as having the best health care policies in the US. When this program began in 1989, the objective of the government was to provide health care services to children who were under the ages of six years, and to pregnant women who were unable to afford private health insurance programs. In 1992, the government of Vermont was able to increase the health care coverage of the Dr. Dynasur program. This was to cover children and teenagers who were under the ages of 17 years; this is up from the previous six years covered by the 1989 Dr. Dynasur plan (Deary and Brown, 2001).
The main aim of this policy was to ensure that children and pregnant women are able to access preventive care, and pre-natal health care services. Another important goal of this policy was to ensure that the state government is able to assist families in achieving self-sufficiency, by helping them carter for their medical needs (Abrahamsen, 2012). This was in line with the state’s welfare system that was assisting families that did not receive the welfare money. As discussed earlier, this policy was very efficient, and it resulted in the ranking of Vermont as a state with the best health care policy in the United States. In 2006, the government of Vermont introduced the Catamount Health care policy (Almgren and Lindhorst, 2012). This health care policy targeted people who were not insured by the Medicaid and Medicare policies. The main aim of this policy was to reduce the medical costs suffered by chronic patients. In 2011, the state government of Vermont introduced a new health care policy.
This health care policy was to create a single health care payer system, under the Green Mountain Care program. The law that enabled the introduction of this policy is the H. 202 law. Under this policy, all citizens of Vermont are required to get a universal health care cover. This policy also helped to improve the technologies used to provide health care services to the citizens of Vermont (Almgren and Lindhorst, 2012). This policy is enacted to replace the system whereby only a segment of the society is able to access insurance health care policies. That is the pregnant women and children covered under Dr. Dynasur insurance plan, and chronic patients who were not covered by Medicaid and Medicare, under the Catamount policy. This policy hasn’t yet achieved efficiency due to a number of problems in its implementation. This is partly due to the passage of the affordable care act, and uncertainties on the methods of financing the program (Deary and Brown, 2001).
Outcomes of past reforms:
As of the year 2005, the Vermont Public Assets institute and the children’s forum released a report indicating that the minimum wage of Vermont’s public sector was unable to keep up with an increase in the cost of the basic needs of the people of Vermont (Almgren and Lindhorst, 2012). According to this report, the biggest factor that led to an increase in costs of living was the health insurance. This insurance cost doubled for the last five years, and this represented 25% of the house hold expenses (Maclean, 2007). This was during the period of 2003. It is important to denote that during this period, Vermont was implementing the Dr Dynasur insurance policy, which was very effective in catering for the needs of people eligible for the policy. It is very important to understand that the Dr. Dynasur policy was a very effective policy in reducing the health care costs of pregnant women, and children under the ages of 18 years old.
For instance, since the introduction of the Dr. Dynasur policy, the Government was able to enroll 90,000 children who were under the federal poverty level (Maxwell, 2012). It is important to understand that the childhood population of Vermont at that time was 150,000 children. 90,000 represent more than half of the total population of Children in Vermont. Based on this ground, this program was able to achieve equity in terms of health insurance coverage (Deary and Brown, 2001). This is because the remaining 60,000 children could afford private insurance cover. However, this policy failed to reduce the insurance costs of all citizens of Vermont (Abrahamsen, 2012). This is because it was discriminatory in nature, because it did not cover the entire population of Vermont; hence an increase to health insurance costs. This is because the people left out in this policy resorted to acquiring private health insurance policies (Maxwell, 2012).
On this basis, the Catamount health care policy was introduced in 2006 for purposes of catering for the needs of those people not covered by the Medicaid and Medicare insurance policies (Maclean, 2007). This policy was very effective in reducing the medical costs of people living with chronic diseases. This is because the government of Vermont catered for their needs, through this health care policy (Abrahamsen, 2012). On this basis, the Catamount Health Care policy was able to reduce the health care insurance costs for the citizens of Vermont. By reducing the health care costs of citizens of Vermont, the Catamount Health Care plan was able to fulfill the social welfare policy of Vermont, which is to make it possible for equitable distribution of health care programs (Maxwell, 2012).
However, as of 2011, the government of Vermont decided to improve on its health care insurance programs, and hence the creation of the Mountain Care Program. This program is still under the implementation stage, to judge its outcome (Abrahamsen, 2012). This is because of the uncertainties over the funding of the program, and how to integrate the whole program, under the affordable care act. However, the intention of this program is to eliminate medical costs of all citizens of Vermont, irrespective of their social class. This is because it will make it possible for the entire citizens to enroll for an insurance program controlled and funded by the state (Maclean, 2007).
Current Steps under ACA:
In satisfying the provisions of the Affordable care act, Vermont has initiated a number of policies. One such policy is the introduction of the health insurance exchange. This is the market place for health insurance. Under this health insurance policy, an individual who purchases the policy before the 15th of January, then the person under consideration must enroll for the health care coverage that begins on the 1st of January, if the person purchases the policy on the 15th of February, and then the coverage of the person under consideration begins on the 1st of May (Alker, Brooks and Harbelein, 2014).
What this refers is that the coverage normally begins 15 days, after the day of purchase. This policy further goes on to exempt people who have enrolled for the health care coverage before the 1st of May, from paying enrollment fees. By 31st of March 2014, the enrollment of people for this program came to an end, and those not enrolled would be barred from accessing the benefits of health insurance up to November 2014, when the next enrollment begins (Alker, Brooks and Harbelein, 2014).
In bringing these services closer to people, the state has established a website referred to as the Vermont Health Connect. This website enables citizens of Vermont to make applications of the insurance policies, compare the prices and plans of various health care policies, etc. It is important to denote that the government of Vermont has shifted the responsibility of managing health insurance to Green Mountain Care Board, established by the 2011, H202 law. Previously, the responsibility of managing insurance health care was undertaken by the Banking, Securities, and Insurance Health Care Administration (Deary and Brown, 2001). The state has also initiated a number of policies in regard to Medicaid under the ACA. For instance in Vermont, any individual making below 139% Federal Poverty Level is eligible for Medicaid. This is under the expansion plan of Vermont in regard to implementing the provisions of the Obama care.
It is important to denote that applications are only acceptable through the Health Insurance Exchange that is operated and managed by the Green Mountain Care organization. Under the Medicaid expansion program, there are a number of plans available, and these plans include the bronze, silver, gold, and platinum plans (Maxwell, 2012). The Bronze plan is a low cost plan Medicaid program offered by the government of Vermont. It has a very low actuarial value, and very low premiums. The actuarial value of this plan rests at 60%, and this means that 60% of all medical costs are catered for by insurance companies. The Silver plan on the other hand comes next, in terms of the costs that an insurer has to pay (Alker, Brooks and Harbelein, 2014).
The silver plan gives an actuarial value of 70%. This is an indication that 70% of medical costs are catered for by insurance organizations, while 30% is catered for by the individual concerned. This plan is recommended for people who are reasonably healthy, and occasionally use medical services Alker, Brooks and Harbelein, 2014). The Gold plan on the other hand comprises an actuarial value of 80%, and on this basis, 80% of medical costs will be paid by insurance organizations. The beneficiary will therefore pay the remaining 20%.
Finally, members holding the platinum plan contribute the highest premium, and it covers 90% of all medical costs incurred by the beneficiary. This plan is suitable to people who are sickly, and of poor health. It is important to denote that health insurers in Vermont are not obligated to offer all these plans, but they are required to offer at minimum, one silver, and one gold plan.
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There are a number of anticipated outcomes for the enactment of the project under consideration. For example, in Vermont, the policies enacted will lead into an increase in the number of the insured people in the state. This is because the policies of Dr. Dynasur and Catamount policy did not adequately cover all the people in the State. For instance, statistics indicate that Vermont has a total number of 47,000 people who do not have any medical cover. This policy will ensure that these people are eligible for the cover, and hence reducing their medical costs. It is important to denote that this policy will have a lot of outcomes when it comes to Medicaid. For instance, initially, Medicaid had a variety of gaps, in the number of people eligible for enrollment (Alker, Brooks and Harbelein, 2014). This is because eligibility was only restricted to people with disability, low income individuals, children, and the elderly.
However, with the expansion of Medicaid to involve other people, Vermont hopes that the policy will lead to an improvement in the medical conditions of its people. This is because there will be an increase in the number of people enrolled into the program. These are people, who were previously not eligible to access the services of Medicaid. Furthermore, with the implementation of this program, chances are high that the living conditions of people will improve (Burkhauser and Lyons, 2011). This is because they will have the capability to save their incomes, and use it for other purposes, other than worrying on how they will pay for their health needs.
Chances are also high that there will be a series of innovations, aimed at effectively implementing these policies. Take for instance in Vermont, the state managed to create a website whereby people can apply for the services of Medicaid (Alker, Brooks and Harbelein, 2014). This website is interactive in nature, and it is referred to as Vermont Health Connect. On this basis, it is important to understand that a series of such kind of innovations will occur. This in turn will improve the efficiency of service delivery.
Barriers to Reform and Changes:
The Health insurance exchanges serve as the main health insurance market places. At a start, these insurance health exchanges will provide insurance cover to people, and business organizations that have an employee base of around 100 people. Federal subsidies will play a great role in minimizing the insurance premiums charged to the middle and lower income people, and insurers will have to meet a variety of conditions set forth by the Federal government (Holtz, 2008). However, there are a number of challenges that the implementation process of these policies will face. One challenge is governing the health insurance exchanges.
It might be difficult to govern these health insurance exchanges, and this is because they are new concepts that emerged. However, in managing these health insurance exchanges, there is a need of the state establishing an independent body that is exempted from certain administrative laws, and governmental regulations. The people in charge of governing this agency should be government representatives and representatives of insurance stakeholders, and the consumers in general. Another challenge that comes into place is the issue of high risk customers. These are customers whose health is very bad, and hence insurance providers will always be unwilling to give them insurance cover.
The state will have to develop a policy such as subsidizing the premiums paid by these customers, for purposes of helping them access insurance cover. Politics is another serious challenge to the implementation of these policies, and this is because of the differences between the Republicans and democrats on the enactment of the ACA. To address this problem, there is a need of constant communication by the governor of Vermont, highlighting the importance of these policies to its people.
Abrahamsen, E. (2012). Health insurance issues, challenges and perspectives. Hauppauge, N.Y.: Nova Science Publishers.
Alker, J., Brooks, T., & Harbelein, M. (2014). The new state-level health insurance exchanges that are to be established under the Affordable Care Act (ACA) New York: Kaiser Commission on Medicaid and the Uninsured .
Almgren, G. R., & Lindhorst, T. (2012). The safety-net health care system health care at the margins. New York, NY: Springer Pub..
Burkhauser, R. V., & Lyons, S. (2011). The importance of the meaning and measurement of “affordable” in the Affordable Care Act. Cambridge, Mass.: National Bureau of Economic Research.
Deary, T., & Brown, M. (2001). The USA. London: Scholastic.
Holtz, C. (2008). Global health care: issues and policies. Sudbury, Mass.: Jones and Bartlett Publishers.
Maclean, N. (2007). Distributing health care principles, practices, and policies. Exeter: Imprint Academic.
Maxwell, N. L. (2012). The health and wealth of a nation: employer-based health insurance and the affordable care act. Kalamazoo, Mich.: W.E. Upjohn Institute for Employment Research.
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