Vermont Rolls Out Initial Single-Payor Financing Plan
In May 2011, Gov. Peter Shumlin (D) signed the state's single-payor bill into law, pending a waiver from the federal government. Beginning in 2017, Vermont will provide universal healthcare coverage to all its residents.
Here are some of the main points from Vermont's single-payor financing report:
• Green Mountain Care will provide comprehensive healthcare benefits for all residents, and if individuals have other coverage, such as employer-sponsored insurance or Medicare, GMC would be used as a supplement.
• GMC will pay hospitals and other healthcare providers 105 percent of Medicare rates, though those rates can fluctuate between 100 percent and 110 percent of Medicare depending on the type of GMC plan. The average GMC plan itself will have an actuarial value of 87 percent, meaning the state covers 87 percent of costs and enrollees cover 13 percent copayments and other cost-sharing mechanisms.
• The total cost of healthcare services provided under GMC in 2017 is estimated to be $3.5 billion, which does not include administrative costs. Currently, Vermont residents spend roughly $6 billion annually on healthcare, hypothetically making the single-payor system a cheaper solution.
• The actual funding of Vermont's single-payor system will come from the following sources: individuals and employers ($332 million), Medicare ($1.6 billion), Medicaid ($1.8 billion), a waiver under the Patient Protection and Affordable Care Act ($267 million) and other sources ($209 million).
• Although public financing and taxes are expected to help fund Vermont's single-payor system, the report's authors said, "Many details regarding the structure of a single-payor system in Vermont have not been determined. These details may significantly affect the assumptions underlying our models and therefore the results of our models. As further details are considered and ultimately decided upon, our estimates should be updated."
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