Vermont health care reform
In 2011, the Vermont state government enacted a law functionally establishing the first state-level single-payer health care system in the United States. Green Mountain Care, established by the passage of H.202, creates a system in the state where Vermonters receive universal health care coverage as well as technological improvements to the existing system.
On December 17, 2014, Vermont Democrats abandoned their plan for universal health care, citing the taxes required of smaller businesses within the state.
In 2010, the State Legislature passed S 88 (which included provisions from Act 128), which enabled the state of Vermont to establish a commission to study different forms of health care delivery in the state. Dr. William Hsiao, a Harvard University professor of economics who was an advisor during Taiwan's transition to single-payer health care, was enlisted to design three possible options to reform Vermont's health care. Hsaio, along with Steven Kappel and Jonathan Gruber, presented the proposal to the legislature of Vermont on June 21, 2010.
The three options were laid out as follows:
The commission's proposal ultimately considered the third option to be "the most politically and practically viable single payer system for Vermont," noting that Vermont, "a small state with communitarian values," with its existing network of non-profit hospitals and a medical structure that had shown previous support in state intervention, would be "uniquely poised to pass universal health reform."
Following the proposal, Democratic state senator Mark Larson introduced H 202 on February 8, 2011, titled Single-Payer and Unified Health System. The bill passed the House on March 24, 2011, with 94 votes in favor and 49 against. The bill then passed the Senate on April 26, 2011, with 21 votes in favor and 9 against. The conference report legislation passed the Senate on May 3, 2011 with 21 votes in favor and 9 opposed, and the House on May 4, 2011 with 94 votes in favor and 49 against. Governor Peter Shumlin signed the bill on May 26, 2011.
The signing of H. 202 led to the creation of Green Mountain Care, described by Kaiser Health News as "a state-funded-and-managed insurance pool that would provide near-universal coverage to residents with the expectation that it would reduce health care spending." Governor Shumlin, in a blog post at Huffington Post, described the plan as "a single payer system" that he believed "will control health care costs, not just by cutting fees to doctors and hospitals, but by fundamentally changing the state's health care system." As of January 2013, Vermont was still working out the role of Green Mountain Care and the responsibilities of the bill, as well as how to fund the program. Dr. Hsiao, for example, had proposed an 11% payroll tax on employers, and the administration was required under Act 48 to provide a financing system in 2013. The state also had to align Green Mountain Care with provisions in the Patient Protection and Affordable Care Act, passed by the United States federal government in 2010, which required the creation of a health care exchange in individual states. To launch fully, Green Mountain Care would have had to gain approval from the federal government to use federal health finances to fund the state program.
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