Vermont Health Care Reform Aims for More Coverage, Less Expense, and Better Care

For 2 decades, political leaders in Vermont attempted to pass comprehensive health care reform before Governor Jim Douglas (R) finally signed legislation presented by the Democratic-controlled legislature on 25 May 2006. The Health Care Affordability Act (Act 191) integrated the aim of universal access to health insurance with other initiatives centered on comprehensive coordinated care (especially for people with chronic diseases) and payment reform. “I think that it is the most innovative and important reform that any state has ever passed,” said Kenneth E. Thorpe, PhD, professor of health policy and management at Emory University.

Thorpe, who worked as a health care consultant for the Vermont legislature and helped design the reform effort, said that for years, legislators were focused on solving the problem of uninsured residents. He encouraged them also to focus on making coverage more affordable and of better quality for those who already had insurance. Thorpe pointed out that patients with chronic diseases were the key driver of health care spending, consuming about 70% of the $3.3 billion spent each year. “This really focused the attention onto redesigning the system and promoting prevention, issues that are nonpartisan,” he said.

Still, coming to an agreement on this novel reform was not easy, and not everyone is happy with the result. Many people in the state still strive for more sweeping reform. Gov. Douglas, who earlier vetoed a single-payer plan, has talked about the difficult compromises that were needed before he reached agreement with the legislature. He has also spoken about the need to balance health reform goals with other priorities, such as economic development and education (1).

In 2007, the legislature supplemented Act 191 with follow-up legislation (Acts 70, 71) that enacted chronic disease care pilots, benchmarks, and an electronic medical record pilot. On 1 October 2007, …