Vermont Single-Payer Law Has a Long Way To Go

Then there's the matter of the federal waiver the state will need, the health exchange that must be created, and the financing package that will be necessary to fund the insurance law. The devil definitely is in the details.

Vermont has been easing into healthcare reform since 2006 when the legislature adopted the state's Blueprint for Health, which set into set into motion a series of initiatives to look at chronic condition prevention and care management. Each year since then legislation has been enacted related to a host of healthcare issues, including healthcare cost containment, care coordination, and the adoption of electronic health records.

But the patchwork approach didn't deliver the results state officials felt were necessary to bring healthcare coverage to the almost 200,000 uninsured and underinsured in the state. In 2010, William Hsiao, PhD, a professor of economics at the Harvard University School of Public Health, was hired to develop three design options for a statewide healthcare system that would provide coverage for Vermont residents. Legislation set the parameters for the designs: state-run universal coverage and single-payer plan; a public option to compete with private plans; and a third plan that would be politically and practically viable.

When Hsiao unveiled his plan for universal coverage and a single-payer system in February 2011, newly elected Gov. Peter Shumlin and much of the legislature were already onboard. Shumlin had campaigned on the issue and once in office delivered a five-page strategic plan that detailed the administrative and legislative steps to make Hsiao's design a reality. That plan pretty much morphed into the 213-page H202.