A fight is brewing in one of the smallest states that will have big implications for how health care is funded in the rest of the nation. In 2011, Vermont enacted Act 48, which laid the foundations for what is to become ‘Green Mountain Care,’ a publically-financed, single-payer health care system intended to cover all citizens of the state. Several other states have also begun to follow suit, with Delaware, Massachusetts, New York, Ohio, Pennsylvania and the U.S. Congress all currently in the process of considering proposals.
The act takes advantage of a little known provision of the ACA, Section 1332, which allows states to effectively opt out of the controversial act beginning in 2017 if certain standards are met. Specifically, states that opt out must provide coverage that is at least as comprehensive and affordable to a comparable number of residents without raising the federal deficit.
According to Tess Taylor, Vermont’s former House Assistant Majority Leader and current Executive Director of The VT CURE, a non-profit advocacy group leading an effort to promote GMC, “This is a paradigm shift in the way we deliver health care to Vermonters.” Says Taylor, “It will require all parties, legislators, administrators, health care providers and Vermont citizens, to understand and support Green Mountain Care. We know that this is a heavy lift, and the VT CURE, alongside everyday Vermonters, is committed to seeing it through.”
The next step to obtaining the waiver comes in 2015, when the legislature will be asked to adopt a funding mechanism meant to shift the cost of health care from the backs of small business and more fairly and evenly distribute it across Vermont taxpayers. In 2017, Vermont will require the Section 1332 federal waiver that was set up in the Affordable Acre Act to allow the enactment of Green Mountain Care.
The state led the nation on major national issues such as the abolishment of slavery, marriage equality and most recently the labeling of GMOs and is looking to do so again. If successful in clearing the current hurdles needed to implement GMC, it will again be able to claim the first in the nation title de facto. However, Vermont is not the first state legislature to push a single-payer system into law. Two other states were able to successfully pass single-payer bills through the legislature, however administrative hurdles also derailed them on their path to implementation:
California’s legislature successfully passed SB 840 in both 2006 and 2008, a proposal that would have implemented a single-payer style health care system in the nation’s largest state. Then-Republican Gov. Arnold Schwarzenegger vetoed the bill both times. Though it has been reintroduced in each successive legislative session, the bills have yet to see the same progress as previous iterations.
Hawaii Act 11 of 2009 created the Hawaii Health Authority, to be tasked with establishing a health plan for all individuals in the state. After overriding the veto of then-Republican Gov. Linda Lingle, the Governor refused to implement the bill and it has languished since. Current Governor, Democrat Neil Abercrombie, stated earlier this year that implementing single-payer was the ‘ultimate goal’ for health care reform in the state.