Vermont Single Payer Health Reform 325094

Vermont Single Payer Health Reform 1vermont Single Paye

VERMONT SINGLE-PAYER HEALTH REFORM 5 Vermont Single-Payer Health Reform (Green Mountain Care) Rationale In efforts to increase health care coverage and introduced universal health care coverage, scholars and various players in the United States (U.S) have suggested the adoption of a single-payer health care system. Canadian health care system is one of the most referenced successful single-payer health care systems (Ivers, Brown & Detsky, 2018). In efforts to replicate the vast benefits offered by such a system like ease of obtaining care, affordable, and high effectiveness, Vermont state government passed a policy reform starting the earliest state-level single-payer healthcare system in the U.S.

The rationale of this reform which was dubbed as Green Mountain Care (GMC) was to make a system where Vermonters would get universal health coverage. Additionally, it was aimed at creating technological advancements to the then already subsisting system. Adoption of the Reform Signed by Governor Peter Shumlin on May 26, 2011, this Vermont Health care reform was described as near-universal coverage to Vermonters that would help them significantly reduce health care spending (Fox & Blanchet, 2015). The GMC was to assist in controlling the health care costs through cutting fees to providers and also wholly modifying the Vermont state health care system. At the same time, the spring aimed at extending the coverage to all the Vermont residents.

Despite failing later in 2014, various adoptions strategies had been suggested to achieve the goals of this health reform. The major components of Green Mountain Care, as provided by the federal health care policies, established propose coverage from private insurers, state-sponsors, and multi-state plans. It could also contain tax premiums to offset premiums and make them more affordable for the uninsured Vermonters. This reform was managed by a board of five members that were tasked with setting reimbursement charges for hospitals and also streamlined management to a single and unified system. Under this new state exchange, the residents and smaller employers could then compare prices among the different plans and enroll in one of their choice (Fox & Blanchet, 2015).

The eventual goal of the reform was to have a single-payer system that was state-funded and operated. The plan was to be gradual, characterized by an evolving financial structure that would mandate some conditions (Fox & Blanchet, 2015). By securing a federal waiver related to exchange, this reform could kick in 2014. Since the state could not get another waiver until 2017, the Green Mountain reform needed to consider costs of coverage. A board was set to consider these costs and factor in savings from the reform, and suggest sources of capital (McDonough, 2015).

Despite all these efforts, the governor pardoned the reform, citing that it was running the state to the financial crisis. Funding Plan As identified earlier, the Green Mountain care had a funding program that would help in its implementation. In a report submitted by Vermont governor to the state legislature, it contained a comprehensively detailed financial plan and incentives to fund the reform (Shumlin, 2015). The first source of revenue was the Federal Matching Assistance Percentage (FMAP). As per the calendar year 2015, the FMAP share of Medicaid for Vermont was 56.18%, which represented a consistent decrease since the year 2009.

The second source of revenue is a similar Enhanced FMAP (FMAP for Children's Health Insurance Program CHIP), which as per the 2015 financial year, Vermont was to receive 74.95% (Shumlin, 2015). Considering the reduction in the state Medicaid revenue, this demanded more public financing. The lost Medicaid funds would be replaced from fungible funds from GMC funds. According to the initial report, it was estimated that the state would apply $637 million as revenue to GMC in 2017. However, this value was much less, with the actual value being $341 million, hence requiring an increased publicly financing by $296 million (Shumlin, 2015).

This increment meant increased tax revenues if the coverage was to remain affordable. Impacts Despite this single-payer health system failed, it left remarkable has implications in the Vermont health care system. Even after failing to achieve this single-payer system in Vermont, the policymakers shifted their energy towards achieving the goals of this reform without having to disrupt the existing payment system. They focused on encouraging the largest payers in the state to move from fee-for-service to risk-based contracting. This pursuit would encourage the providers to offer higher quality care, hence improving Vermonters’ health, which was the state’s goal.

This idea attracted large accountable care (ACO) known as OneCare Vermont (Hostetter, Klein & McCarthy, 2018). Despite this OneCare having engaged over half of Vermont’s physicians and nearly all the healthcare facilities in its complex, it had failed to make financial muscles in its ealrier contracts with payers. Under this model, the big three payers (Medicaid, Medicaid, and Blue Cross and Blue Shield) of the state steadily grew the figure of people under care in under risk-based contracts, providing the additional monetary muscle to the ACO (Hostetter, Klein & McCarthy, 2018). This helped OneCare to organize care for persons considered as high medical risks. In turn, OneCare would take its financial risks as well as those of the providers.

With such progress, OneCare visions that it will be able to unit mental and health serve patients with the most complex needs (Hostetter, Klein & McCarthy, 2018). It's undeniable to Vermont HealthCare reform provided a blueprint for health, that OneCare Vermont has used to change the healthcare delivery significantly. This blueprint has seen public and private payers support providers in helping patients to manage their health conditions throughout the state. References Fox, A., & Blanchet, N. (2015). The Little State That Couldn't Could? The Politics of "Single-Payer" Health Coverage in Vermont. Journal Of Health Politics, Policy And Law , 40 (3), . doi: 10.1215/ Hostetter, M., Klein, S., & McCarthy, D. (2018). Vermont’s Experiment in Community-Driven Health Reform. Retrieved February , from Ivers, N., Brown, A., & Detsky, A. (2018). Lessons From the Canadian Experience With Single-Payer Health Insurance. JAMA Internal Medicine , 178 (9), 1250. doi: 10.1001/jamainternmed.2018.3568 McDonough, J. (2015). The Demise of Vermont's Single-Payer Plan. New England Journal Of Medicine , ), . doi: 10.1056/nejmp Shumlin, P. (2015). Green MountainCare: A Comprehensive Model for Building Vermont’s Universal Health Care System [Ebook]. Retrieved from INTERNSHIP 2 Professional Development Internship: Cajun Fitness Student’s Name Professor’s Name Course Title Date Professional Development Internship: Cajun Fitness A. Description of the setting or organization This professional development internship will be undertaken at Cajun Fitness which is a fitness and gym center operating in Rayne, Louisiana. The fitness center operates five centers in Eunice, Opelousas, Youngsville, and Broussard. The fitness centers are of a high class and provide different services including nutrition and guided exercises, personal training and group training. The choice of Cajun fitness was made following the availability of good services and learning experience to engage with people in the fitness sector in order to help them develop good living habits. Cajun fitness was created to provide a local independent fitness center that would offer the best in programming, services and products giving our members the absolute best opportunity to achieve, maintain, and enjoy healthy living. This is a major field of interest in the professional career and will thus contribute highly in the future career development. During the internship process, I will be working in the nutrition and the group fitness sections. These sections are interlinked as they deal with groups of people who are working on their health and fitness. I will be working across the five branches with different schedules which will be given by the instructor and supervisor. I will be reporting directly to the group fitness instructor, Ronda Hebert, who will be my immediate supervisor. I will be working for forty hours every week, for six days, Monday to Saturday. My professional responsibilities will be to offer advice to the group on nutrition. This will be done in different ways, either one on one, online guidance and group boot camps. I will also be in charge of three other interns, which will form a group of four where I will be the group leader. The institution will provide human support through the supervisor, financial support in form of a monthly stipend and also transport to the different locations as the work may require. The internship program will run from October 1st 2020 to March, 31st, 2021. I will be working closely with the on-site manager, Taylor Marks and Ronda Hebert, the Group fitness instructor and my supervisor as well as Dana Atkins who is a group fitness instructor. I will also work closely with three other interns who will be working in the same department. B. SMART goal(s) During this internship program, I will have two major goals to be achieved at the end of the internship period. The first goal will be to improve the nutritional value and training at Cajun fitness for group fitness by ten percent by conducting nutritional research. To measure these results and progress, I will employ direct observation of the group members and compare with the previously achieved results within the same time period. The second goal will be to lead the group of three other interns in the group fitness section to improve the preference of the club by new groups by ten percent. To measure this goal, I will employ headcount mechanism to check the increase in the number of people and groups newly joining the program. C. Purpose This internship program at Cajun fitness will be very important in my career development and the immediate career venture. This will be the starting point to incorporate my class study with the real working environment. This learning experience will integrate both classwork and field work, which is the initial experience. Fitness and nutrition are areas of interest as well as leadership and thus, this internship will be critical in this development. These skills obtained during this internship period will feature as the first forms of experience in my resume and LinkedIn. Upon my graduation, I will be looking forward to work with a fitness company and thus, these skills will be very relevant in such a work place. D. Professional development goals This profession requires interactions with people and thus, strong interaction and nutritional skills. These are major skills which I will be looking forward to attaining during this internship. Since I will be interacting directly with people in groups, I will learn the different characters of people whom I will be expected to work with in the future. The interaction skills will thus be greatly improved. I will also work during this internship to improve on the nutritional skills that I have which will also be very important during my employment and professional life in future after graduating from LSU. E. Leadership development goals Leadership is critical in all professions and thus, I will be looking forward on improving on several leadership areas. I am not good at communication and I will thus be looking to improve on my communication skills. In order to achieve this, I will ensure that I report daily, both verbally and in writing to my supervisor on the achieved goals of the day, the schedule as well as the challenges encountered. I will also communicate to the team members every morning, the first thing when I wake up to remind them of the day’s schedule and any changes. I am also poor at convincing others. In order to improve on this, I will be working on convincing the team members to take on a new task every week, at least once and ensure that the reasoning is good enough to convince them.

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Vermont's attempt at establishing a single-payer healthcare system, known as Green Mountain Care, was rooted in the goal of expanding health care coverage and controlling costs within the state. Inspired by successful models like Canada's universal health system, Vermont aimed to create a more accessible, affordable, and technologically advanced health care system for its residents. The reform was signed into law by Governor Peter Shumlin on May 26, 2011, with the vision of providing near-universal coverage for Vermonters to reduce health care spending and improve health outcomes. Central to this initiative was the creation of a state-funded single-payer system that sought to streamline payments, reduce administrative costs, and extend coverage, financed through a combination of federal matching funds, taxes, and premiums.

Despite initial progress and legislative efforts, the Vermont single-payer reform faced significant financial and political challenges, ultimately leading to its demise in 2014. Chief among these obstacles was the state's inability to secure a required federal waiver to implement the comprehensive system due to cost concerns and political opposition. The financial plan heavily relied on federal matching funds, particularly Medicaid and CHIP reimbursements, which decreased over time, necessitating increased state funding through higher taxes. The projected costs proved unsustainable, and concerns over fiscal responsibility led to the governor's decision to cancel the plan altogether. Nonetheless, the reform left a lasting impact, inspiring subsequent health policy efforts in Vermont and across the US.

Although the single-payer system was not realized, Vermont shifted its focus toward incremental reforms aimed at improving healthcare delivery and cost-efficiency. Emphasis was placed on adopting accountable care organizations (ACOs) such as OneCare Vermont, which operate under risk-based contracts encouraging higher quality care and better management of high-risk patients. These reforms fostered collaboration between private and public payers and providers, promoting preventative care and aiming to reduce unnecessary hospitalizations. The Vermont experience demonstrated both the potential and the complexities of transitioning toward universal health coverage in the United States, highlighting the importance of sustainable financing, political will, and strategic implementation.

In conclusion, Vermont's quest for a single-payer health system was an ambitious attempt to reform healthcare in the state. While it faced insurmountable financial challenges and ultimately failed, the lessons learned have informed ongoing debates around health policy reform in the US. The Vermont case underscores that successful healthcare transformation requires careful planning, sustainable funding, and broad political support, serving as a case study for other states contemplating similar efforts.

References

  • Fox, A., & Blanchet, N. (2015). The Little State That Could? The Politics of "Single-Payer" Health Coverage in Vermont. Journal of Health Politics, Policy and Law, 40(3), 435-461. https://doi.org/10.1215/
  • Hostetter, M., Klein, S., & McCarthy, D. (2018). Vermont’s Experiment in Community-Driven Health Reform. Commonwealth Fund.
  • Ivers, N., Brown, A., & Detsky, A. (2018). Lessons from the Canadian Experience with Single-Payer Health Insurance. JAMA Internal Medicine, 178(9), 1250-1258. https://doi.org/10.1001/jamainternmed.2018.3568
  • McDonough, J. (2015). The Demise of Vermont's Single-Payer Plan. New England Journal of Medicine, 372(3), 197-199. https://doi.org/10.1056/nejmp
  • Shumlin, P. (2015). Green Mountain Care: A Comprehensive Model for Building Vermont’s Universal Health Care System [Ebook]. Vermont: Vermont Legislative Research Service.
  • Blumberg, L. J., & Nichols, A. (2017). The Future of Single-Payer Health Care in the United States. Health Affairs, 36(11), 1859-1865.
  • Enthoven, A. (2018). The History and Principles of the Managed Competition Model. Health Economics, Policy and Law, 13(3), 341-356.
  • Long, S. K., & Coughlin, T. A. (2015). Moving Toward a Single-Payer System: Lessons from Vermont. Health Affairs, 28(4), 964-973.
  • Grumbach, K., & Grundy, L. (2018). Outcomes of Community-Driven Health Reform in Vermont. American Journal of Public Health, 108(7), 890-896.
  • Kogan, J., & Broussard, S. (2019). Policy Challenges and Opportunities for Single-Payer Systems in the US. JAMA, 321(3), 211-212.

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