Affordable Care Act: State Action Newsletter

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May 6, 2011

Vermont Moves Closer to Universal Health Care

Vermont is a few steps closer to becoming the first state in the nation to establish a universal and unified health care system. The legislature finalized action and passed HB 202 and sent the bill on to Gov. Peter Shumlin who is expected to sign the bill into law.

“I think the recognition that our health system is fundamentally broken has really helped to move this bill forward,” says Representative Mark Larson, sponsor of HB 202. “This bill allows us to cover all Vermonters with comprehensive health care while realizing savings and increasing economic opportunities and jobs,” he adds. An April 2011 report by the Vermont Legislative Joint Fiscal office and the Vermont Department of Banking, Insurance, Securities and Health Care Administration concluded that the reformed system would achieve savings. A study and report by a team of researchers was also commissioned by the state.

Establishing “Green Mountain Care” will depend on receiving the needed federal waivers and the legislative approval of a financing plan, among other things. “Our plan for reform meets the president’s challenge to states to innovate and build upon the federal law. We will be asking for a waiver to use the resources available through the ACA to cover even more people through our reformed system,” says Larson. He also says that Vermont is “very excited about HB 202 and is ready to demonstrate that it can work.”

Increasing Managed Care in Medicaid: A Complex Discussion

As states look for ways to contain costs in Medicaid programs, legislators are debating the pros and cons of increasing managed care this year. Different from the fee-for-service payment model, where providers are paid for each health care service, managed care pays providers a fixed monthly rate for providing a defined set of medical services for each patient.

Proponents of managed care believe this payment model provides better incentives to prevent and manage diseases before costly interventions are needed. Managed care also offers states more budget predictability through fixed price contracts. Some consumer advocates, however, worry that it directs resources away from beneficiaries and toward profits for managed care companies.

The debate concerning Medicaid managed care is more complex than just how to create the correct incentives. “Medicaid is increasingly becoming a managed care program, a significant trend as the states gear up for a massive expansion required by the federal health care law,” Phil Galewitz wrote in an Kaiser Health News article on April 26. Medicaid enrollment is expected to grow by 16 million people nationwide after the 2014 expansion, making it an even larger part of states’ health care economies. In the article, Matt Salo, executive director of the National Association of Medicaid Directors, says, “Whenever you are changing the way you do [state Medicaid] business, you are going to have winners and losers.” For a copy of the article, click here.

Five State Legislatures Pass Exchange Bills - Waiting for Action from the Governor

As many legislative sessions head toward the home stretch, legislatures in at least five states are closer to establish health insurance exchanges. Bills in Colorado (SB 200), Hawaii (SB 1348), North Dakota (HB 1126), Vermont (HB 202) and Washington (SB 5445) passed both chambers and are awaiting the governor’s signature. These bills establish exchanges that intend to meet the minimum requirements outlined by the Affordable Care Act. Colorado’s bill has been a major topic of the legislature this past week. On Wednesday, May 4 the bill passed the Republican-controlled house, 44-21 vote, with 20 of the House’s 33 Republicans and one Democrat casting votes against it. The Senate concurred to changes on Thursday, May 5. Colorado Governor Hickenlooper (D) is expected to sign the bill. New Mexico’s Governor Susan Martinez vetoed SB 38, which would have established the New Mexico Health Insurance Exchange. So far, Maryland, Virginia, and West Virginia have new laws to establish state health insurance exchanges that were enacted in 2011.

Partnership Aims to Curtail Health Care-Acquired Conditions

Health and Human Services (HHS) Secretary Kathleen Sebelius announced on April 12 the Partnership for Patients Initiative, a national program aimed at improving patients’ safety by preventing hospital-related medical errors and dangerous infections—also known as health care-acquired conditions—with $1 billion in financing through the federal health reform law (ACA). This new public-private partnership brings together leaders of major hospitals, employers, physicians, nurses and patient advocates, along with state and federal governments in a shared effort to potentially save up to 63,000 lives and $35 billion in health care costs over the next three years, according to HHS. Health care-acquired conditions—such as infections, pressure ulcers or bedsores, falls, blood type incompatibility, air embolisms, problems from medical equipment being left in a patient’s body following surgery—can be attributed to as many as 187,000 deaths and 6.1 million injuries a year. According to a recent report by Health Affairs, one-third of hospital patients acquire one of these conditions, costing as much as 45 cents out of every dollar of total national health care spending. States play an important role in improving patient safety as purchasers, regulators and providers of health care services. At least 27 states and the District of Columbia require data collection and reporting related to health care-acquired conditions, and 10 require the information be made public for consumers. In 2006, Pennsylvania became the first state to report on hospital-acquired infections, and in 2007 the state passed a comprehensive law (Act 52) to prevent, track and report all hospital-acquired conditions. In Florida, the Agency for Health Care Administration tracks and reports health care acquired-conditions, sharing their best practices with hospitals and ambulatory surgical centers. In addition, the Florida law requires licensed health care risk managers to assess quality and improve patient safety processes within health care facilities.
State efforts to curtail health care acquired-conditions have shown success. Rhode Island reduced central-line associated bloodstream infections by 42 percent, while 150 health care facilities in New Jersey lowered pressure ulcers by 70 percent.

Pennsylvania reports that hospitals across the state gradually have become more effective in preventing infections. For example, Moses Taylor Hospital in Scranton, has reduced infections caused by central catheters by 80 percent and urinary tract infections by 33 percent since 2006.

 Grantee

 First Year Awards (2011) 

 Funds Committed Through 2016 

 Colorado Department of Health Care Policy & Financing

 Florida Agency for Health Care Administration, Medicaid

 Idaho Department of Health and Welfare, Division of Medicaid

 Maine Department of Health and Human Services

 Massachusetts Executive Office of Health & Human Services, Office of Medicaid

 Minnesota Department of Human Services

 Mississippi Division of Medicaid, Office of Health Services

 Nevada Department of Health & Human Services, Division of Health Care Financing & Policy

 New Mexico Human Services Department, Medical Assistance Division, Long Term Services & Supports Bureau

 Rhode Island Department of Human Services, Division of Health Care Quality, Financing & Purchasing / Medicaid Division

 Tennessee Bureau of TennCare

 Vermont Department of Disabilities, Aging and Independent Living

 West Virginia Department of Health & Human Resources, Bureau for Medical Services

 TOTAL