Coming in 2017: Vermont's single-payer system

AP: The little state is leading the way on health care reform

Vermont is on track to launch the nation's first universal health care system in 2017, which state officials have promised will offer access to and coverage for "high-quality, medically necessary health services" for all residents.

The status of the state's single-payer plan

Green Mountain Care (GMC), which was approved and signed into law in 2011, will:


  • Provide a pre-determined package of coverage benefits to each state resident;
  • Shift providers from the traditional fee-for-service system to one that bundles payments; and
  • Be funded in part through $1.6 billion in new taxes on state residents.

The 2011 law created a five-member oversight board that already has launched four pilot projects with the goal of reducing health care costs statewide. For example, one payment bundling program combines costs into a single set price for services that commonly are provided together, such as anesthesia, surgery, and follow-up physical therapy for a knee replacement.

GMC is not designed to provide coverage to federal employees in the state or those with self-insured employers who assume the risk of their own coverage and are governed by federal law. It also might not serve residents who obtain coverage from employers with headquarters in other states, according to Vermont Association of Hospitals and Health Systems Vice President Jill Olson.

HHS has yet to approve a waiver allowing Vermont to use federal funds to finance GMC. State Health Director Robin Lunge says a decision likely will be finalized late in the Obama administration's final term. The state previously has obtained similar waivers allowing it to make changes to its Medicaid program.

Additionally, Vermont must secure legislative approval for a state financing plan, which has yet to be developed.

AP: The little state with a big plan

According to the Associated Press, Vermont is uniquely situated for a universal health care system because the state:


  • Is considered to be the most liberal state, with Democrats holding the governorship and both houses of the Legislature;
  • Has a tradition of activism for such a program, with residents frequently holding rallies to promote universal health care;
  • Is small—with a population of about 626,000 and a total of 15 not-for-profit hospitals—which makes it a manageable setting to test a universal health care project; and
  • Already is close to achieving a key goal of a universal health care program, with 91% of the total state population insured.

Observers raise some concerns

However, America's Health Insurance Plans (AHIP) is warning that the state's 2011 law could limit consumer options and might not be sustainable.

"The plan could disrupt coverage consumers and employers like and rely on today, limit patients' access to the vital support and assistance health plans provide, and put Vermont taxpayers on the hook for the costs of an unsustainable health care system," AHIP spokesperson Robert Zirkelbach says.

Some observers also have questioned the expected cost savings of eliminating multiple insurance companies and their different coverage and billing styles (AP/U-T San Diego, 10/26; Gram, AP/Yahoo! News, 10/26).


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