Vermont - One Payer States

Vermont
Written by Betty J. Keller, MD, PNHP, League of Women Voters VT

Context for State-based SP bills in Vermont

In 2011, the VT legislature passed and Governor Shumlin signed Act 48, putting VT on a path to try to get as close to a single payer universal health care program as possible. Due to impediments in federal law, it was not going to be able to realize the savings of a single payer system, but it least it would ensure health care for all Vermonters, without the risk of medical bankruptcy. When the ACA was rolled out, it actually made the task harder, but the greatest problem was the fiasco with the rollout of Vermont’s ACA market exchanges, which reduced confidence that the leadership in Vermont could competently administer a health insurance program. How that went so horribly awry is still unknown.

This history leads to two features of the advocacy landscape in Vermont: 1) Promoting state-based single payer would have to be customized to the circumstances, with participating in a regional single payer system with some combination of New England States and New York perhaps being the best “fit”, and 2) there has already been a great deal of education of the public, businesses, and legislators about single payer, with broad-based support for a national system, and support for states like California and New York to pursue state-based SP, but reluctance to try to do it alone as a small state.

Related legislation

H 225 An act to explore the creation of a regional universal health care program: https://legislature.vermont.gov/bill/status/2020/H.225

Status: Failed, (but see Act 63 which incorporates some of the provisions of H 225)

Sponsor: Rep Yacavone

H 524: An act relating to health insurance and the individual mandate; with several other provisions including in Section 9 (4), a mandate to “explore the potential for establishing a regional, publicly financed, universal health care program in cooperation with other states, including identifying the opportunities and challenges that would be presented by partnering with other states to create such a program.” A report needs to be presented by December 2019.

Sponsor: Rep Yacavone

Status: After 3 readings and many amendments it was passed and signed by the governor. It is now Act 63. https://legislature.vermont.gov/Documents/2020/Docs/ACTS/ACT063/ACT063%20Act%20Summary.pdf

H 129 An act relating to a universal, publicly financed primary care program for Vermont

(This is not a single payer bill, but is listed here as a bill that seeks to improve access to primary care doctors.)

Status: In House Committee on Health Care

Sponsors: Rep. Brian Cina and Rep. Kevin Christie

Obstacles to SP in the current context

Our small size, our geography (lots of perimeter relative to area of state; rural nature, mountains in middle),
our climate (much of year is too cold for outdoor rallies or inhospitable for door-to-door canvassing);
our limitations in resources (“people power” and money);
the mischaracterization of VT’s previous efforts as a “failure” of Single Payer.

Goals for SP movement in VT 2019-2020

1) continue educating the public, healthcare providers, and legislators about universal publicly-funded health insurance, with a goal toward creation of a national health program; a regional health program; or a state-based program in a state large enough for state-based universal health insurance to be viable

2) support education and advocacy efforts of people in other states, especially those states with a realistic possibility to implement state-based single payer or regional single payer; or in states with insufficient numbers of health care activists to make progress on their own.

3) address misinformation and purposeful distortion of facts

4) promote development of healthcare professionals with advocacy, teaching, and leadership skills

Shorter-term initiatives

Revisit Act 48 (Green Mountain Care, see history above) to see what gains can be made in our current setting

Where can people find news about Single Payer in your state and/or join a group?

Physicians for a National Health Program-VT: https://pnhp.org/chapter/vermont/

League of Women Voters of VT: https://my.lwv.org/vermont/position/health-care

Vermont Health Care for All: http://vermontforsinglepayer.org/;

Vermont Workers’ Center: https://www.workerscenter.org/; (802) 861 4892.

Rights and Democracy Vermont: https://www.radvt.org ; (802) 448-0326. James Haslam.

lwvofvt.org