The Affordable Care Act as an Experiment: Data We Have, Expect to Have, and Should Have, from a Vermont Pilot Study

Abstract

The ACA as an experiment offers a great deal of variation across states and affords the opportunity to amass plenty of data that are key to interpreting the success of ACA-related policies. Since the state of Vermont has a history of insurance reforms that mimic the ACA (and dually has an ultimate goal of single payer health insurance coverage), there is a unique opportunity for evaluating similar state and ACA goals.

As far back as 1991, the state legislature passed guaranteed issue and community rating so that insurance carriers could not deny coverage to customers or charge discriminatory rates based on demographic and heath status factors. And, like Massachusetts, Vermont has used its Medicaid program creatively to cover as much of their population as possible.

An all-payer claims dataset has been in place for 5 years in Vermont. Medicaid has recently been integrated into the dataset and Medicare will soon be. This will be a rich source of claims data for analysis and planning going forward, but will require much work to make it useful to multiple parties.

Beginning in 2014 small-group and non-group markets will be required to purchase insurance through a state exchange. Vermont is the only state to require that all purchasing for small-group and individual coverage occur through the Exchange. Vermont is also the only states to locate its Exchange within a state Medicaid agency. The reason for this is a desire on the part of state policy makers to ensure enrollment in coverage and transitions between coverage. Between private and public insurance are as seamless as possible.

Because there are programs such as these in place to improve data collection, activities much consideration has been made about what questions to ask of the data. Unfortunately, there is not a strong national data collection framework in place that can guide Vermont and the other states. Even though there will be much state variation in implementing the ACA, data collection strategies must be coordinated, and standard measures must be set by the federal government. We can look to early pioneers in Vermont, Massachusetts, and elsewhere for early lessons learned.