American Adults More Likely Than Europeans To Be Diagnosed With, Treated For Chronic Diseases

Higher U.S. Disease Rates Contribute Up To $150 Billion In Annual Health Care Spending

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Christopher Fleming

Vermont’s Catamount Health Reforms: The View From The Governor’s Office

In Health Affairs Interview, Gov. Jim Douglas Calls Compromise And Systemic Reforms The Key To Enacting 2006 Legislation

Bethesda, MD -- After reaching an impasse in 2005, Vermont’s Republican governor and Democratic legislature were able to agree on landmark health reforms in 2006 by avoiding ideological extremes and combining coverage expansion with steps to make care more cost-effective across the board.

That’s the message delivered by Vermont governor Jim Douglas in an interview published today on the Health Affairs Web site. “Ultimately, we worked together to find the common ground,” Douglas tells James Maxwell, the director of Health Policy and Management Research at the JSI Research & Training Institute in Boston.

In the interview, Governor Douglas describes the legislation that he and the Democratically controlled state legislature enacted in 2006. The reforms coupled Catamount Health, a state-subsidized coverage program for those below 300 percent of the federal poverty level, with initiatives such as wellness programs and a statewide disease management effort known as the Blueprint for Health. Vermont needed to act, Governor Douglas says, because “Vermonters, and many other Americans, are tired of waiting for Washington to get its act together on this issue.”

Governor Douglas emphasizes that the Blueprint for Health and other steps to make care more cost-effective for all Vermonters were for him crucial elements of the 2006 reforms. “It comes back to cost control. I’ve often said that we need to bend the cost curve,” the third-term governor tells Maxwell. “If we don’t reduce the cost of care, all of our pockets are going to be empty.”

In 2005, says Governor Douglas, he had vetoed a Democratic plan, Green Mountain Health, that focused primarily on expanding coverage using increased payroll taxes. In 2006, rather than reprising this fight, the governor and legislative leaders like Senate President Pro Tem Peter Welch (D) broadened their focus to include systemic reforms to reduce costs and improve quality. On coverage expansion, the governor and legislators found a middle ground “between those who wanted a taxpayer-financed, government-run system and those who did not.” Vermont uses private insurers to run Catamount Health but provides state subsidies to make the coverage affordable.

Governor Douglas explains that he and Democratic leaders were also able to reach agreement on financing for Catamount Health: “As I indicated in 2005, I would not support higher payroll taxes. But I did agree in 2006 to higher cigarette taxes of sixty cents per pack. This made sense to me, as we want to discourage smoking through our health care reform plan. There is also an employer assessment -- one dollar per day for each uninsured employee.”

Vermont did not include a requirement that all state residents purchase health insurance -- known as an “individual mandate -- in the 2006 legislation. “An individual mandate would not get us to universal coverage in this state,” says Governor Douglas, who notes that some Vermonters do not have car insurance even though it is mandated. “It is better to reach out to the uninsured population and encourage and enable them to be insured by providing affordable options.”

Ken Thorpe’s Perspective: Improvements For Those With Coverage
Were Crucial To Passage Of Catamount Health Plan

In a Perspective on Governor Douglas’ conversation with Maxwell, nationally known health policy expert Kenneth Thorpe credits the inclusion of systemic reforms like Blueprint for Health with making the 2006 reforms possible. After the 2005 impasse, Thorpe was hired as a consultant to the Commission on Health Care Reform cochaired by Jim Leddy and John Tracy, the Democratic chairs of the health committees in the state Senate and House, respectively.

Thorpe writes that Vermont legislators faced two choices for 2006: They could pass a refined version of Green Mountain Health, which would lead to another gubernatorial veto, or they could “reframe and broaden the debate to lead with clear proposals designed to lower the cost of health insurance for the 90 percent of Vermonters with health insurance.” Legislators chose the second option, assuaging the fears of those with insurance that they would be required to pay more to cover the uninsured while receiving nothing in return, says Thorpe, the Robert W. Woodruff Professor and Chair of the Department of Health Policy and Management at Emory University’s Rollins School of Public Health in Atlanta, Georgia.

“Ironically, the Vermont plan passed because of and not in spite of its comprehensive approach for reforming health care. There were just too many ‘commonsense,’ nonpartisan improvements to the health care system included in the proposal not to enact it,” Thorpe observes.



Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at


©2007 Project HOPE–The People-to-People Health Foundation, Inc.