In 2011, the Vermont legislature passed Act 48, a plan to provide universal health coverage to all residents. One of the goals of the law was to ensure greater “fairness and equity” in how Vermonters pay for health care (Agency of Administration, 2012). Implementing a state-based universal coverage plan will entail significant shifts in how health care is financed in Vermont. As the Vermont legislature and administration implement the law, it is important to understand how health care is financed today and the degree of fairness and equity present in the current system.

In this analysis, we estimate total health...

In 2011, Vermont passed Act 48, a plan to implement Green Mountain Care (GMC), a universal, publicly financed health insurance program that could be available to all Vermont residents as early as 2017. Act 48 potentially positioned Vermont as a leader in the next wave of health reform in the United States. According to the Congressional Budget Office (CBO), the ACA will leave 30 million individuals—10 percent of the U.S. non-elderly population—without health care coverage (Congressional Budget Office, 2014b). Vermont’s proposal could provide coverage to all residents, and could provide lessons for future reforms in other states. In...

The goals of this incidence analysis are to estimate

payments by Vermont residents for health care in calendar year 2012

health care benefits received by Vermont residents in calendar year 2012

payments and benefits in calendar year 2017 in the absence of a new universal coverage plan

the distribution of payments and benefits across different population groups and types of individuals

We estimate the payments and benefits in 2017 assuming that state and federal health care policies continue on their current path, i.e., in the absence of the major reforms outlined in Act 48. These 2017 estimates are intended as...

In 2012, 49 percent of Vermont’s residents were insured through ESI. Other major sources of health insurance coverage in the state included Medicaid and CHIP, Medicare, and the Vermont Health Access Plan (VHAP). Table 3.1 shows the distribution of health care coverage for Vermont residents in 2012 in RAND’s underlying database, which is derived from a modified version of the VHHIS. Our modifications are described in more detail in the appendix; they include appending the VHHIS income data with modified adjusted gross income estimates from the Vermont tax department and adjusting the Medicare and Medicaid totals to match administrative information...

Table 4.1 shows total spending on the value of health care benefits in Vermont in 2012 and as projected for 2017. We estimate that, in total, Vermont residents spent about $5.1 billion on the value of health care benefits in 2012, and we project that this number will grow to $6.8 billion by 2017. The 2012 estimate is within 1 percent of 2012 spending total reported in the Vermont Expenditure Analysis, a remarkable degree of consistency given that we used different methods and in some cases different data. Our 2017 estimate, $6.8 billion, is higher than an estimate of $5.9...

In this analysis, we estimate the incidence of who pays for health care in Vermont, and we attempt to characterize the equity in the system under current policy (that is, policy that includes the ACA but not the universal coverage reforms that may be implemented as part of Act 48). We consider two forms of equity:Vertical equitymeasures the degree to which individuals with higher incomes pay more for health care, andhorizontal equitymeasures the degree to which individuals with the same incomes pay the same amounts for health care.

One of our main findings is that a...