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Volume 27, Issue 467 |
May 15, 2006 |
VERMONT APPROVES “CATAMOUNT HEALTH,” CHRONIC CARE INITIATIVE
By Christina Kent
Following months of wrangling between the Democratic-controlled Legislature and the Republican governor, Vermont took another step toward its goal of universal coverage.
On May 10, just hours before adjourning for the year, lawmakers passed a compromise version of H.861, which will create a new insurance program for uninsured Vermonters, as well as refocus the current health system toward chronic disease management.
The legislation, which Gov. James Douglas said he would sign, will create Catamount Health, a standardized health plan that (at least initially) will be voluntarily offered by private insurers to uninsured persons. The state will determine a comprehensive set of benefits that will include primary, preventive and chronic care, as well as acute episodic care and hospital services. Enrollees will not have to pay for preventive care or for recommended services for chronic illnesses. The benefits will be actuarially equivalent to the Selectcare point-of-service plan administered by Cigna in the state.
The state estimates that about 25,000 of the currently 60,000 uninsured Vermonters will take up Catamount Health. The program will be financed by enrollees (who will pay premiums based on income), as well as fees that will be assessed on employers who do not provide coverage, an increase in tobacco taxes and federal funds. (The state administration is to seek an amendment to its current Medicaid waiver for services provided to Medicaid-eligible individuals.) Anyone with an income under 300 percent of the federal poverty level (about $60,000 for a family of four) will receive subsidies for their premiums.
H.861 also broadens the scope of the “Blueprint for Health,” the state’s public/private effort to improve chronic disease prevention and management care. The legislation directs the state’s commissioner of health to collaborate with the public and private sectors to develop a five-year strategic plan for integrating chronic disease prevention and care into public and private health plans, communities and systems of care. According to a consultant, Vermont can save $550 million over the next ten years by developing and/or disseminating common outcome measures, best practices and protocols, data reporting requirements and payment methodologies.
“This bill is an important first step in living up to the Legislature’s commitment to controlling the skyrocketing costs of health care,” House Speaker Gaye Symington said at a press conference. “It accomplishes that goal two ways: by making health care affordable and accessible to Vermonters who are currently uninsured and by establishing an outstanding system of chronic care management.”
“There are many points of view about the bill but I think all Vermonters would agree that this is a step forward,” Douglas said. The governor had threatened to veto earlier versions of the bill and agreed to sign the last one only after agreement was reached on a three-step process for offering Catamount Health. First, private insurance companies will have an opportunity to sell Catamount Health insurance. If this does not work, then the state will mandate that insurers offer Catamount. After two years, the Health Care Reform Committee will determine whether that approach was cost-effective. If not, then the state will assume the risk and contract with a third-party administrator to manage Catamount Health.
Not everyone was pleased with the results. “This bill will certainly cover more people, but it is not significant health-care reform,” Rep. David Zuckerman told the Rutland Herald. Meanwhile, the National Federation of Independent Business/Vermont opposes tax increases of any sort to finance a new health system or the current one, and instead supports legislation that would facilitate the sale of health savings accounts.
CDC URGES SOME STATES TO ALTER THEIR HIV TESTING LAWS
By Christina Kent
States that require written consent and lengthy counseling for HIV testing may want to reexamine their laws in light of recommendations from the Centers for Disease Control and Prevention (CDC).
Currently, some states require that patients sign a separate consent form before being tested for HIV. And many mandate that patients receive a 20-minute counseling session before being tested for the infection.
But the CDC is concerned that the counseling and consent requirements, enacted before anti-retrovirals and other life-sustaining anti-AIDS drugs were developed, deter people from getting tested. As a result, those who don’t know they’re infected can’t benefit from the highly effective drug therapy that exists, and they also may unknowingly pass the infection on to others. The CDC estimates that about one-quarter of the 1 million people living in the United States with HIV don’t know they’re infected.
“We do HIV testing differently than we do any other test in medicine,” said Dr. John Bartlett, a leading researcher in HIV/AIDS at the Johns Hopkins University. “You have this medical legal form and you have to explain it all. And then you have to sign it, and the patient has to sign it. It’s an incredible burden and most people are frightened by it.”
The CDC guidelines, which are expected to be made final in June or July, seek to make HIV screening a routine part of medical care. The draft version, released last March, recommends that states and others not require separate written consent for HIV testing, nor counseling for the patient at the time of testing. Instead, patients could be told orally that an HIV test is recommended and they could choose to opt out of testing. The CDC also recommends that HIV screening be included in the routine panel of prenatal tests for pregnant women; again, pregnant women could choose to opt out.
In early May, New York Assemblywoman Nettie Mayersohn introduced a bill (A11075) that would amend existing New York law (which requires written consent) to allow patients to orally agree to HIV testing, much as they would agree to a mammogram or cholesterol test. If the patient tests positive, they would be offered counseling and treatment.
“I think it’s a bill that should have been passed many years ago,” said Mayersohn. “We need to start treating HIV as we treat any other disease.” She noted that New York has approximately 6,000 new cases of HIV each year – more new cases than in any other state. In 2004 alone, 1,038 New Yorkers learned they had HIV when they already were sick with AIDS. “This is the goal: to stop the epidemic,” Mayersohn said. “We just have to stop treating it as a civil rights issue. It’s not a civil rights issue, it’s a public health issue.”
However, a number of AIDS advocacy groups have criticized the CDC’s recommendations. Ann Fisher, executive director of the AIDS Legal Council of Chicago, told the Chicago Tribune that while she agrees with the CDC’s ultimate goal, the proposal itself is a “terrible” idea. “A diagnosis of HIV isn’t routine, and we shouldn’t be treating it like it is. This is something that changes people’s lives, often very dramatically.” She also disagreed with the proposal to eliminate requirements for counseling before testing. “That’s the time when you want to be educating people and talking about prevention.” Fisher and others also wondered whether and how all the additional people who are newly found to have HIV would be able to find programs that would pay for their care. Currently, it costs $30,000 to $40,000 to pay for the care of one person with HIV for one year, Bartlett said.
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