Vermont
April 20, 2023 By
Written by Betty J. Keller, MD, PNHP, League of Women Voters VT (interim update by OPS staff)
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.
For articles discussing why the Vermont history is not a lesson against Single Payer, including for example, the extent to which the Vermont bill was not a Single Payer bill, but one that authorized private 3rd parties (and thus minimal potential for savings)–See OPS archive materials here.
Single Payer Bills
The bill, H.276, was introduced in 2/2021 into the House with 44 co-sponsors. This bill phases in a universal health care system they called “Green Mountain Care.” It starts with Universal Primary Care, including outpatient mental health and substance use disorder treatment. It then adds other sectors of care until we have universal access in all sectors of care.
February 2023, the bill to implement Green Mountain Care was re-introduced as H 156. It would establish the Universal Health Care Advisory Group at the Green Mountain Care Board to provide 14 recommendations to the General Assembly regarding the sequencing of and financing for the health care services to be added in the third through tenth years of Green Mountain Care’s implementation. The bill would also express legislative intent regarding funding sources for Green Mountain Care and would prohibit health insurance plans and rates from reflecting duplication of the coverage provided by Green Mountain Care.
Related legislation
H 225 (from 2020) 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
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
See what gains for Green Mountain Care (see history above) can be made in our current setting
Where can people find news about Single Payer in your state and/or join a group?
VT Physicians for a National Health Program: https://pnhp.org/chapter/vermont/
League of Women Voters of VT: https://my.lwv.org/vermont/position/health-care
Vermont for Single Payer (was VT 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
VT Organizations
State-based SP organizations
VT Physicians for a National Health Program:
Vermont Health Care for All Dr. Deb Richter drdebvt@sover.net
Vermont Workers’ Center (802) 861 4892
Rights and Democracy Vermont (802) 448-0326. James Haslam
National SP organizations with significant presence