An historic event occurred on May 26th 2011.
The New York Times noted it with a single paragraph.
On that date, Vermont Governor, Peter Shumlin, “launch(ed) the first single payer health care system in the United States” by signing into law H-202 passed by the Vermont legislature just days earlier.
ACA paves the way
The Vermont law could only be possible in the wake of the Patient Protection and Affordable Care Act (ACA) signed by President Obama 14 months earlier.
That point may be missed by those who criticize the ACA as meaningless and the Vermont bill for falling short of the single payer ideal. Yet the ACA paved the way for the Vermont initiative in several ways.
First it established a national will for health care reform. Despite the bluster and the moneyed and mindless opposition to health care reform, the public has repeatedly expressed support for health care reform, even if not for this health reform legislation. As Canadian survey researcher, Oleh Iwanyshyn, notes in the blog, poll stuff, Americans may not like or understand many of the specific initiatives in the bill, but they clearly supported and continue to support health care reform.
Failure can also show a way
The failures of the ACA also opened a door for the Vermont initiative. The health care exchange idea is still a complex and confusing idea to most people. There is only one part of it they truly understand. Sick people cannot be denied health care insurance. But all of the emerging guidance and discussions about eligibility for Medicaid and subsidies and exchanges is very confusing.
The world was looking for someone to simplify this system and Vermont had an idea.
The ACA paved the way for Vermont in another way. The ACA was modeled after another state initiative, a state very close to Vermont, a state Vermonters were able to observe very closely – Massachusetts. Like ACA, the Massachusetts was an historic achievement. It was the first state since the passage of ERISA in 1976 to find a way around that law’s “preemption”.
Vermont unties the knot
The ERISA preemption severely limits the power of states to enact laws establishing universal health care coverage. Hawaii’s employer mandate, passed the year before ERISA, was granted an exemption in 1983 with the clear message that other states should not expect similar treatment. Massachusetts found a way to cut through this Gordian knot with the individual mandate.
Here is the curious rub to this history. Supporters of the ERISA preemption in 1976, like Senator Jacob Javits from New York, also supported, and in fact, expected, a federal health care reform effort. They did not want states to put up roadblocks to that effort. Why, 35 years later, when Congress has a clear public mandate for health care reform, does it look to a model whose only merit is that if finds away around the federal restrictions?
Lastly, the ACA does provide a legal framework to encourage state initiatives for health care reform. They got into the law over the objections of the White House and they are not effective until 2016, but they are there.
So Vermont took the bait. They did what Congress and the President were too weak-kneed to do. They enacted a law that blazes a path toward a single payer system in Vermont.
This initiative could not have happened without significant grass roots effort. That effort preceded H-202 and the ACA by several years. It is they that deserve the credit for this historic achievement.
Next: a closer look at the new Vermont law.