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Dr. Dynasaur 2.0 Cost Shift

Understanding Dr. Dynasaur's Cost Shift To Private Insurance.

Because publicly funded health insurance programs like Medicaid pays less than what health care providers need for many services, the shortfall is made up or “cost shifted” through the bills of private insurance companies like Blue Cross Blue Shield. These insurance companies then raise the rates for their private insurance products “cost shifting” their under reimbursement expenses to the people they insure.

According to a study of Vermont by the University of Massachusetts, from 2014-2017 medical payment rates as a percent of Medicare are 155% for commercial and 82% for Medicaid. The resulting cost shift to private payers from Medicaid is estimated to be more than $183 million for hospital and physician care.

The Dr. Dynasaur 2.0 campaign believes the State of Vermont must raise Medicaid’s reimbursement rate for health care providers to be paid fairly for treating enrollees in the program.

The Insured

Currently, more than half of all Vermonters received their health insurance from a publicly funded source such as the military, Medicare, Medicaid or as a public employee.

Green Mountain Care: A Comprehensive Model for Building Vermont’s Universal Health Care System

The Uninsured

Vermont has the second lowest uninsured rate in the nation at 3.7% or roughly 23,000 people. Of these uninsured, 1,342 are aged 0-18 and 4,567 are aged 19-26 representing roughly 25% of the uninsured population.

Most uninsured Vermonters are among the poorest Vermonters. For example, 2,370 of the uninsured Vermonters aged 19-26 are in households with income limits under $16,243 for a single person or $33,465 for a household of four).

Vermont’s “Underinsured” population

While Vermont has a strong record in ensuring its resident have insurance, many of those covered still face out of pocket costs such as deductibles, co-pays, co-insurance and out of pocket maximums that make seeking health care too expensive. These Vermonters are known as “the underinsured”- the have health insurance but effectively can’t get health care or have to limit the amount of care they seek because of cost.

The State of Vermont’s annual Household Health Insurance Survey defines someone as “underinsured” if:

  • The deductible for the private health insurance coverage exceeds 5% of a family’s income and/or
  • A family earned 200%FPL or less and their out of pocket expenses for medical care exceeds 5% of family income.
  • A family earned more than 200%FPL and their out of pocket expenses for medical care exceeds 10% of family income.

The Survey also found that nearly one in three (27%) of privately insured Vermonters is underinsured. Shockingly, 63% of those aged 18-24 are underinsured, by far the highest of any age bracket:

And it’s the poorest Vermonters on private health insurance that are by far more likely to be underinsured:

  • 90% of the Vermonters on private insurance earning less than 100%FPL (under $11,770/yr for a single person) are underinsured
  • 69% of the Vermonters on private insurance earning 100-199%FPL (between $11,770-$23,540/yr for a single person) are underinsured.
  • Only 10% of the Vermonters on private insurance earning over 400%FPL are underinsured (more than $47,000/yr for a single person).

THE COST OF DOING NOTHING

Doing nothing is not an option.

»Click here to see why

2.0 PROMISE

If it doesn’t make sense for Vermonters, we won’t do it.

»LEARN MORE

2.0 SNAPSHOT

The nuts and bolts of Dr. Dynasaur 2.0.

»VIEW THE SNAPSHOT

VIDEO

A detailed look into our campaign to reform health care in Vermont.

»SEE THE VIDEO

TESTIMONIALS, ADVOCATES & SUPPORTERS

See what others are saying about Dr. Dynasaur expansion.

»VIEW TESTIMONIALS

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