Vermont Action Center

American Cancer Society Legislative Wrap-up 2011

Enhancing Access to Health Care - Health Care Reform

The ACS is dedicated to ensuring that all Vermonters have access to timely, affordable and quality health care by ensuring the implementation of the federal Affordable Care Act (ACA), and that state programs remain viable and affordable sources for health care coverage.  Historically, cancer patients and survivors have faced many challenges in an effort to find adequate, affordable health care.  The barriers can be significant and are a major obstacle to achieving our goal to reduce cancer incidence and mortality.  The reforms in the ACA and in H. 202 represent a profound structural change in how private insurance will operate and how consumers and patients will utilize the health insurance system.

Catamount Health Plan: the legislature rejected a House proposal that would have dramatically raised Catamount's $500 deductible and $1,050 annual out-of-pocket limit. The legislature instead opted to decrease the Catamount reimbursement rate paid to providers and limited the insurance carrier's administrative expenses to 6%.   This is good news for beneficiaries of the Catamount Health Plan and a huge success in a very difficult budget year.

Health Care Reform, H.202:  the Vermont health benefit exchange established by this legislation will begin enrolling individuals and small employers for coverage beginning January 1, 2014 (consistent with federal law). The intent is to establish the Vermont health benefit exchange in a manner that it becomes the foundation for Green Mountain Care (GMC).  GMC is a public-private universal health care program designed to provide health benefits through a simplified, uniform, single administrative system.

Major Components

• Appointing GMC Board (to control health care cost growth) through a nominating committee
• Establishing the Vermont Health Benefit Exchange (to reform health insurance purchasing and administration, consistent with federal law)
• GMC (an overall statewide program to provide universal access and maximize cost savings)

Green Mountain Care Board

• Responsible for Vermont's health care system that currently lacks integration and systemic coordination.
• Independent from executive and legislative branches. Five members, nominated by a new Green Mountain Care nominating committee and appointed by Governor with consent of Senate
• Oversees and evaluates payment reform at all levels - primary care, specialty care, hospital care - aimed at moving from payment for volume to payment for value
• Builds on and maximizes savings from Blueprint for Health
• Develops overall budgeting with a reasonable rate of growth
• Eliminates cost-shifting going forward
• Provides strategic planning for Vermont's health care system through comprehensive data systems, adequate staffing and expert analysis

Vermont Health Benefit Exchange

• Consolidates purchasing and simplifies purchasing of health insurance:
• Creates an easy to access consumer website for health insurance, one-stop-shopping
• Provides Vermonters with apples-to-apples comparisons
• Provides access to federal health insurance subsidies.
• Will ensure outreach to Vermonters and simple enrollment
• Acts as the "engine" of health care reform - implements payment reform and administrative simplification for as much of the population as possible
• Maximizes administrative simplification for patients, employers and providers

Early Detection - Maintain level funding for the Ladies First Program: did not face budget cuts this fiscal year.  ACS continues efforts to raise awareness around the importance of sustaining a safety net program for vulnerable women. 

Moratorium on Specialty Tiers, S.104: prohibits insurers from assessing a greater coinsurance, copayment, deductible or other out-of-pocket expense for non-preferred brand name drugs than for preferred brand name drugs for one year, which allows more time for the legislature to closely examine the impacts of cost-sharing.  While we do not have a formal position on this provision, we agree with the premise of limiting patient out-of-pocket costs for treatment.  Also, as costs to patients rise, we know they sometimes choose not to pursue therapy or go with a choice that is less expensive and often less effective, another outcome we should all strive to avoid.

Prevention -- Tobacco Control

Tobacco use causes more than 800 Vermont deaths each year. It is the single most preventable cause of death and disease in Vermont.  Approximately 17% of adult Vermonters and 16% of youth in grades 8 through 12 identify themselves as current smokers. One-third of all tobacco users will die prematurely because of their addiction to tobacco.

Tobacco Tax:  ACS fought hard for passage of a $1.00 increase in the cigarette tax, but in the end it was not to be.  The House passed a 27 cent increase in the tax, which was increased to a $1.00 by the Senate Finance Committee and supported by the Senate Health and Welfare Committee, but was then reduced down to passage of a 53 cent increase in the Senate after much strong-arming by the Governor, a final tax increase of 38 cents was passed out of conference committee and included in the Misc. Tax Bill passed by both chambers.

ACS is disheartened by the final increase.  Though it will result in an increase in Vermont's cigarette tax from $2.24 to $2.62 (effective in July), a price increase must be at least 10% of the total pack price in order to have a public health benefit.  Vermont would have needed at least a 65 cent increase to accomplish this.  The 38 cent increase simply provides the state with a small amount of revenue without providing a significant deterrent to youth or substantial incentive for smokers to quit.  

As noted in a press release we sent out in collaboration with the Coalition for Tobacco Free Vermont, the Governor's actions to block a significant increase in the cigarette tax only hurt the population he claimed to want to help.

"Low income smokers are four times more likely to quit in response to a significant cigarette tax increase and thus would have been more likely to end up getting a big tax cut. But the Governor has chosen a route that will cause them to pay more for cigarettes, yet not enough to quit -- causing their health care costs to rise while disposable income decreases.  It's a move that only makes tobacco companies healthier."

Tobacco Control Program funding:  the tobacco control program was faced with a $2.1 million cut; the legislature restored $900,000 to the program.  The new total program funding for FY2012 is $3.31 million.  While certainly disappointing, the bright spot on the horizon seems to be that the Administration has expressed a willingness to provide more funding for smoking cessation in the future and VDH will be using federal funding to make up for some of the lost state funding as well as reworking other program components (with the restored state funding) to best achieve the program's goals. Though some of the harm of the state cuts was able to be prevented via federal funding, VDH expects a much greater impact in FY13 if state funding is not restored as much of the federal funding is one-time monies that will be eliminated.

The biggest impacts of the cut will be on cessation and media. 

• Cessation --   Quit-in-Person Counseling will be eliminated as a result of the Governor's proposed cut, Vermont Dept. of Health (VDH) is working with the Blueprint for Health to look at transitioning the expertise of the Tobacco Counselors to the Community Health Teams.  The on-line and phone portion of the tobacco program's cessation services remain intact. 
• Media - VDH will use some federal funding to supplement its media/counter-marketing efforts, but due to the significant cut in state funds, the new proposed $788K in spending is well below the current fiscal year's $1.3 million total.  Media common theme campaigns have, in the past, focused on secondhand smoke, youth prevention and adult cessation.  However, the secondhand smoke campaign will be eliminated to ensure that the other campaigns are funded at a level that will ensure enough media reach to make an impact.  VDH will be using existing inventory of media spots to save on media development costs and purchase as much airtime as possible. 

Tobacco Trust Fund:

Unfortunately, the Tobacco Trust Fund has been viewed as one of the largest funding streams available to make up for budget shortfalls. A $9 million transfer from the fund in FY11 and a more than $8 million transfer from the fund proposed by the Governor for FY12 will leave the fund with a balance of just over $6 million. 

Prevention - Nutrition and Physical Activity

Overweight and obesity represent a serious and growing health problem in Vermont.  The science linking excess weight, physical inactivity and poor nutrition to cancer is now well established. One-third of cancer deaths that occur in the U.S. each year can be attributed to poor diet, physical inactivity, and overweight and obesity.

Complete Streets Bill, H.198 passed the legislature: the bill that passed requires state and local transportation planners to consider incorporating complete streets policies -- the needs of all users and all abilities -- into all paved roadway projects.  If after they consider complete streets policies, they cannot accommodate all users regardless of age or ability, then they have to report and document which of the following exceptions applied:  1) Use of the transportation facility by pedestrians, bicyclists, or other users is prohibited by law; 2) The cost of incorporating complete streets principles is disproportionate to the need or probable use; or 3) Incorporating complete streets principles is outside the scope of a project because of its very nature. 

Reduce Consumption of Sugar Sweetened Beverages (SSB), H.151: the bill was assigned to House Ways and Means Committee where it had a public hearing, the bill was not voted on in committee.  We also had an opportunity for a public hearing in the House Health Care Committee.  We will continue to work with our partners on this issue to education and raise awareness about the importance of reducing consumption of SSB.

Quality of Life - Pain and Palliative Care

Hospice and Palliative Care, H.201: This bill brings Vermont into line with the rest of the country by requiring continuing medical education (CME) on palliative care and hospice for all doctors. Until now, Vermont was one of only six states with no mandatory CME on this subject. This new requirement will help physicians understand the advances in palliative care and hospice services and their place in the range of available medical services. This wills, in turn, help patients get the information they need to make informed choices about their treatment and will increase access by assuring that physicians recognize the role of palliative care and hospice in treating their patients.  ACS supports improving access to palliative care and hospice.