HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, January 29, 2013

Health Care Reform in Vermont--The Next Wave?

While most of the country continues to tie itself in knots agonizing over the Affordable Care Act, debating whether it is a good or bad thing, deciding whether it is truly a "government take-over" of health care, and keeping the courts and government bureaucrats busy responding to the endless questions about the law and its implementation, another small New England state may be acting as the laboratory for the next wave of health care reform (remember, Massachusetts was the model for the ACA).  In 2011, Vermont passed a law authorizing the creation of a universal single-payer health insurance system, to be known as "Green Mountain Care" (the current name of the state's public programs, such as Medicaid),  According to the Associated Press, this small state next door to Canada wants something closer to the Canadian health-care system for its citizens, rather than the hodge-podge of coverage options that Americans seem to treasure.  As a resident of another state that borders Canada, where I  hear stories about Canadians coming to the United States to get medical treatment that they would not be able to receive as quickly in Canada, as well as Canadians residing in the United States returning to Canada to get medical treatments that they cannot get at all in the United States because they can't get insurance or can't afford to pay for them privately, I find Vermont's decision to emulate a Canadian-style system interesting.  The Vermont law lists as its purpose "to provide, as a public good, comprehensive, affordable, high-quality, publicly financed health care coverage for all Vermont residents in a seamless and equitable manner regardless of income, assets, health status, or availability of other health coverage."  Clearly, Vermont lawmakers decided that the possible inconveniences of waiting lists and delays were outweighed by the evils of being unable to get treatment at all.  It's a courageous decision, and it will be interesting to see how it unfolds.

The Vermont system can't be implemented until 2017, because the state will require a waiver from the ACA, and those won't be available until 2017.  Nevertheless, the governor has been under pressure to explain how much the system will cost and how it will be financed, and last week, Governor Shumlin released a report that said that the state's share of the cost of the new system will be $1.6 billion, out of a total cost of $3.5 billion.  The difference will presumably be covered by federal contributions and assorted private payments.  Although this sounds scary, the report notes that most individuals and employers would no longer be buying private health insurance, and that would result in a savings of $1.9 billion.  The major criticism of the system is coing from people who say the cost is simply too high.

Will the Vermont experimentt be the forerunner of the next wave--a single-payer health system in the United States?  Or is the cost really too high?  We will have to stay tuned.


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