State reform updates

I’ve been staffing the annual meeting of the Council of State Governments/Eastern Regional Conference health policy track meetings in Atlantic City, NJ. Today we heard updates from states at varying stages of reforming their health care systems – Maine, Massachusetts, Vermont and New Jersey.
Sen. Joseph Vitale described New Jersey’s comprehensive plan to cover all 1.2 million uninsured residents. Phase I was just signed into law expanding SCHIP for parents. They are starting an insurance mandate for children, but there are no penalties attached to it yet. Policymakers decided against any employer contribution. They allow families with higher income children to buy into the program at full cost – similar to HUSKY Band 3 – at a cost of about $137 per child per month (twice that for two children and three times that for three or more children in a family). The law increased the minimum allowed medical loss ratio for managed care companies from 75% to 80% -- CT has no standards for medical loss ratios. Phase II will include coverage for everyone not eligible for existing programs, will be self-funded, provide a benefit package similar to the most popular small group market product, and will reimburse providers at commercial rates.
Sen. Richard Moore updated the conference on Massachusetts’ reforms. The rate of uninsurance has dropped from 13% two years ago when Chapter 58 passed to at least 7% and possibly as low as 4% now – over 355,000 people have found health insurance. Not only has Massachusetts found no evidence of crowd out (employers dropping coverage assuming workers can join the new public programs), in fact employer sponsored insurance rates have increased since Chapter 58 passed two years ago. Uncompensated care spending is down 34%. Fewer state residents report not being able to access care due to cost, and medical debt is down. Public support for the reforms is strong and growing. Reforms of the non-group market have made insurance far more affordable and enrollment is up 50%. Despite this rosy picture, challenges remain. Residents who have chosen to remain uninsured may be difficult to convince, covering the underinsured, workforce shortages, and containing health care costs. To contain costs, a new law just signed by the Governor addresses price transparency, health information technology adoption, regulation of drug company gifts to providers, prohibits billing for “never events”, CON reforms, and a medical home demonstration project.
Jim Hester, Director of Vermont’s legislative Health Care Reform Commission, described Catamount Health which also passed in 2006. The Commission is a legislative oversight body that follows the implementation of reforms closely and is critical to the state’s success. 5,800 Vermonters have joined Catamount Health and 4,300 have newly enrolled in state programs. Vermont is having difficulty getting the federal government to honor its commitment to their global Medicaid waiver at promised funding levels. This year Vermont enhanced their reforms by expanding coverage for children on their parents’ policies to age 23 and a large increased investment in health information technology paid for with a 0.2% fee on paid claims across all payers. Vermont is also expanding their successful Blueprint for Health plan to reduce the prevalence and provide chronic care management for diabetes. ER use is down by 40% for patients in the self-management program.
Phil Saucier, from Maine’s Governor’s Office of Health Policy & Finance, talked about progress covering the uninsured. Their Dirigo health plan passed in 2003 and now covers about 18,000 Mainers. The state has taken the federal government to court arguing that they are owed financial support for the program. The state repealed the contentious savings offset payment mechanism to fund the program in favor of a flat fee on all payers, including self-funded plans, of 1.8% of claims as well as taxes on alcohol, tobacco and soda. The soft drink industry has mounted a referendum on the November ballot to repeal the tax on soda – a “people’s veto”. The state also increased the age children can stay on their parents’ policies to 25, prohibited billing for “never events”, created medical home pilots, and are addressing overtreatment inefficiencies.
Ellen Andrews