Vermont wants state employees to join OneCare Vermont, as part of an effort to revamp its all-payer model.
About 19,000 of Vermont’s 25,000 state employees, retirees and family members who receive health insurance from the state would be eligible to be added to the state’s all-payer model, which is run by OneCare.
The remaining 6,000 are retirees on Medicare, said Beth Fastiggi, commissioner of the state Department of Human Resources.
The move is the latest effort to add more people to the state’s health care reform experiment, after the federal government warned Vermont in September that it had fallen behind on its participation targets.
Mike Smith, human services secretary, vowed Thursday to make significant changes in the all-payer model to make it more effective and to further increase participation.
State employees had opted out of participating last year, voicing concerns about whether it would have a negative impact on their health care. “I think it’s important for the state of Vermont to lead by example,” Fastiggi said.
The change wouldn’t affect health insurance for state employees, Fastiggi said. Employees would continue to receive the same coverage at the same cost through Blue Cross Blue Shield. They would not be at risk for losing money, at least for 2021. Not all the 19,000 would automatically be in OneCare, she added — only those whose primary care doctors also participate in OneCare.
Steve Howard, president of the Vermont State Employees’ Association, said the union will bargain over the proposed change. He said he didn’t know whether the membership would support the shift.
“Clearly, there are always concerns when someone wants to do anything in the realm of health care because it’s such an important benefit working for the state,” he said. “We’re always very cautious about any changes.”
OneCare administers the state’s all-payer model, which aims to change the way health care is paid for. Doctors participating in OneCare are paid for each patient, rather than for each procedure they perform. That’s meant to incentivize them to keep people healthy rather than performing more costly procedures.
The system is effective only when the vast majority of Vermonters participate.
So far, about 223,000 people are enrolled in the model, about 42% of the eligible population. The state was supposed to reach 58%, or about 322,000, by the end of this year. In 2021, about 238,000 people will participate.
Another large Vermont union also decided not to participate last year. Darren Allen, spokesperson for the Vermont-NEA, the teachers union, said the group that manages teachers’ health insurance hadn’t decided whether it would participate in OneCare in 2021.
After hospital officials also complained that participation in OneCare was too pricey with the strain of the pandemic, OneCare cut annual dues. A few independent practices also left the network.
In September, the Centers for Medicare and Medicaid Services warned that Vermont had failed to meet its targets for two years in a row, and it will likely fall short in 2020 as well. In response, Smith vowed to “reboot” the system, and proposed a set of sweeping changes.
Howard said state employees spent the last year doing research on OneCare and will continue to look into the proposal in the coming weeks.
“I don’t want to panic our members, or them to think they’ve lost their health care plan,” he said. But he also didn’t want to move blindly forward into OneCare. “We’re always on high alert,” he said.
