Gov. Peter Shumlin’s news conference on uninsured, part 1.
The number of Vermonters without health insurance has dropped by nearly half since 2012, according to a new survey commissioned by the state.
Gov. Peter Shumlin welcomed the results Monday, saying they affirm that the stateās effort to implement the federal Affordable Care Act has led to great progress āwhen it comes to covering uninsured Vermonters who have been struggling for years without health insurance.ā
There are now close to 23,000 people without health insurance, down from 43,000 in 2012 — when the survey was last conducted — according to the Vermont Household Insurance Survey.
Vermontās uninsured rate of 3.7 percent is the second-lowest in the nation. Only Massachusetts, which implemented reforms similar to the Affordable Care Act in 2006, has a lower rate.
The growth in coverage is largely attributable to the ACAās increase in the income eligibility for Medicaid, the government health program for the poor, according to state officials.
Vermontās expanded Medicaid rolls raise questions about whether the programās low payments to doctors and hospitals, which are set by the state and cover less than two-thirds of their actual cost, could undermine beneficiariesā access to medical services.
Low payments also cause health care providers to shift the losses incurred in treating Medicaid patients to commercial insurers, who then pass those costs on to their customers.
Medicaid provides coverage for 45 percent of people under age 18 who have health insurance, versus 20 percent for adults, according to the survey. That makes it a major source of coverage for children in Vermont.
āAs we drive more Vermonters to Medicaid, which is why weāre seeing such great news on our uninsured rates, we are exacerbating the cost shift,ā Shumlin said, adding that the low rates will eventually either put providers out of business or stop them from treating the programās beneficiaries.
Shumlin said his forthcoming budget, should he be confirmed by lawmakers, will include increased provider reimbursements for Medicaid, but he would not say how he plans to spend or whether it would require new revenue.
In January, more than $8 million in federal Medicaid payments included in the ACA will cease. Vermontās current budget, which runs through June, does not replace those enhanced payments.
A 1.6 percent increase for overall reimbursements was struck as part of $31 million in spending cuts made last summer. Each dollar the state puts toward Medicaid draws down $1.17 in federal match, so cutting the increase saved Vermont $3.4 million, but also cost $4 million in matching funds.
Fixing a ābrokenā payment system
The cost of medical services and health insurance are the ābiggest challengeā people face in getting the care they need, Shumlin said Monday.
More than 65 percent of the uninsured said the high cost of insurance is either the sole or main reason theyāre not covered. The household survey shows 2.6 percent of insured respondents said they have skipped medical care because it was too expensive, while 17.6 percent of the uninsured said the same, according to the survey.
Those rates are even higher for dental care, which many private insurance plans donāt cover. Medicaid has a dental benefit of $510, which many advocates say is insufficient.
As part of his ādisappointingā announcement that he would not pursue a single payer plan this year , Shumlin said he has also laid out an āambitiousā agenda for Vermont to lead the nation in reducing the cost of health care, while also improving quality.
Topping that agenda is changing how health care services are paid for, he said.
āI want Vermont, by Jan. 1, 2017, to be the first state in the nation that pays for health care based on outcomes and quality, instead of the current system where we pay for quantity,ā Shumlin said.
Without making those changes, the cost of health care will continue to rise faster than peopleās income and faster than the growth in Vermontās economy, he said.
The governor is pursuing a federal waiver that will allow the state to set how and how much Medicare pays doctors and hospitals, allowing that program to participate in payment and delivery reforms already being made to Medicaid and commercial insurance.
He will also seek to increase payments for doctors in the stateās Blueprint for Health managed care program, and seek to expand the Green Mountain Care Boardās authority to accelerate payment reforms, Shumlin said.
Survey methodology
The 2014 Vermont Household Insurance Survey was conducted by Maine-based Market Decisions.
Survey interviews were conducted by phone between August and December. Calls were made to cellphones and landlines, with 41 percent of respondents being surveyed on cellphones.
The firm spoke to 4,052 randomly selected households, covering roughly 8,923 residents, including 322 people who were uninsured. The results were then weighted and extrapolated for the stateās entire population.
Gov. Peter Shumlin’s news conference on uninsured, part 2.