Health Care for All Takes Big Stride in Vermont

Vermont nurses union President Mari Cordes stands with a state senator at a January "Health care is a human right" event at the Statehouse. Photo: Jobs with Justice

Article updated May 5

Vermonters are as close to winning “single-payer” health care legislation as residents of any U.S. state have ever been, but they are fighting for every inch as they near the goal line. Legislation ensuring health care for all has passed both houses and was reconciled May 3.

Activists dominated legislative hearings with their message that health care is a human right, but business interests—including IBM, the power company Entergy, and health insurer MVP—are pouring resources into weakening the legislation.

In the Senate, a poison pill was added in the eleventh hour: undocumented workers would be excluded from coverage. “Farmworkers need health care, too,” said James Haslam of the Vermont Workers Center. “We are not Arizona!”

Many undocumented immigrants work year-round in Vermont’s dairy industry, as well as during the state’s short harvest season. Vermont Workers Center activists said that if the language stayed in, it would be the first time Vermont had officially discriminated against people on the basis of their immigration status.

The legislature’s reconciliation committee stripped out the section that excluded undocumented workers this week.

The change followed the largest health care march yet in Montpelier on May 1. The marchers, who included undocumented dairy workers, demanded that the anti-immigrant provision be removed, despite the warnings of some political allies that the campaign would be marginalized for standing up for undocumented workers.

The final bill is expected to pass before the legislature adjourns May 6. It would then go to Governor Peter Shumlin, who made single payer the cornerstone of his election campaign last fall.


For months, community members and union nurses have been testifying and marching for the bill, which would guarantee comprehensive health care to all Vermonters. With “single payer,” all health care bills would be paid out of one public fund, rather than a tangle of private insurers looking to boost their bottom lines.

Two hundred medical students from around the country converged on the Capitol in Montpelier March 26 in their short white coats chanting “Everybody in, nobody out” to the rhythm of a brass ensemble. One carried a sign: “Vermont Single Payer—Show California How It’s Done,” referencing that state’s years-long fight to pass such a bill.

Opponents have warned that doctors will leave the state if the bill is enacted, but when Shumlin asked the crowd if they would come to the state to practice medicine under the new system, the aspiring doctors cheered.

Disgusted with the capitulation to private insurers that marked last year’s national health care reform, single-payer advocates across the country have been inspired by the Vermont effort. The national legislation is expected to leave 23 million uninsured, according to Physicians for a National Health Program.

In Canada, comprehensive health care started in Saskatchewan, a largely rural province with 3 percent of Canada’s population. U.S. single-payer advocates hope the power of a good example could cause a chain reaction here, despite Vermont’s tiny size.

What’s in the Bill?

What does Vermont’s health care bill do?

  1. Creates a health care system, Green Mountain Care, to “provide comprehensive, affordable, high-quality health care coverage for all Vermont residents,” overseen by an independent board representing patients, providers, and employers.
  2. Provides health care for every person “regardless of income, assets [or] health status.”
  3. Directs the governor to come up with a funding plan by 2013.

What are unions and advocates fighting to fix?

  1. They’re concerned the bill places cost containment over human rights goals (for example, by allowing co-pays).
  2. They want to prevent private insurance companies from collecting premiums. The House bill anticipates a continuing role for private insurance.
  3. They want to prohibit companies from keeping their workers out of the system. Everybody in, nobody out!


The Vermont campaign started three years ago with a patient grassroots outreach effort led by the Vermont Workers Center, a Jobs with Justice affiliate.

Jonathan Kissam, a strategist for the campaign, remembers being told there was no chance state leaders would even talk about health care until federal legislation passed.

But the workers center, along with some unions, didn’t wait. They organized committees in every county in the state, reaching out to new people and developing them as activists.

“We had lots of single-payer advocates, but no one was out talking to working people or getting a grassroots base,” said Kissam, a former officer of the United Electrical Workers in Burlington.

The nurses’ union, an AFT affiliate, has been active from the first, said President Mari Cordes. A recent survey showed her union’s members support the bill 3 to 1, she said.

Organizers used the framework “health care is a human right” in all their campaigning, which included five principles: universality, equity, accountability, transparency, and participation.

After years of surveys, town meetings, and postcard drives to representatives, when the Vermont House held public hearings in February, single-payer advocates came out by the hundreds to speak at 15 locations around the state.



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So few citizens spoke against the bill that the Senate rearranged its hearings to try to find more opponents. But when testimonies were taken by alternating “pro” and “con,” opponents couldn’t fill the “con” slots.


Now that passage looks imminent, “legislators are getting more behind-the-back pushes,” said Peg Franzen, president of the Vermont Workers Center. Employers are using “scare language,” saying anything to make people afraid.

“But we don’t really have a system now,” she said, noting that 66,000 Vermonters are uninsured and thousands have lost health care because of unemployment and underemployment.

Cordes works at Fletcher Allen, the state’s biggest hospital. She said many patients have complications that could have been prevented and are sicker because they didn’t have access to health care.

Patients go home from the hospital, Cordes said, and discover their insurance company won’t pay for maintenance supplies, such as catheter filters that need changing regularly. When patients can’t afford supplies, they risk life-threatening infections.

“Over and over again we hear the same stories,” she said.


“We’ve changed the conversation so everyone is for reform,” said Traven Leyshon, president of the Green Mountain Central Labor Council. “The question is, what is the content of the reform?”

While saying they’re supportive, big employers are trying to weaken the bill, proposing a system where competing health insurance companies could cherry-pick young and healthy applicants, leaving the sicker and more expensive patients in a fund the state would underwrite.

As the bill traveled through the House, restrictions on private insurance were loosened.

In addition, IBM and Fletcher Allen have their own insurance plans for their workers. Cordes said the big companies profit from their health insurance plans by pocketing a portion of premiums.

Because of this, big employers want exemptions from the statewide plan. But if the legislation allows them to withdraw, funding for the whole system could collapse, Leyshon said. Then the plan would resemble the weaker “public option” floated in last year’s national health care debate, not a universal “Medicare for all” plan.


IBM, Vermont’s largest private employer, seems to be opposed to single payer on ideological grounds, while Blue Cross, the state’s largest insurer, hasn’t opposed the bill publicly because it is angling for a contract to administer the plan, activists said.

Some yes voters in the legislature may tolerate single payer, Leyshon said, only because it will reduce health care costs. They may support only minimal coverage, though, which would fall short of what activists have worked so hard for.

The nurses are working with the Workers Center to make sure the bill “comes out of the sausage-making process not tilted toward corporate interests,” Cordes said.

The current legislation doesn’t include a funding mechanism, but instead requires the governor to design a funding plan by 2013 and present it to the legislature.

Advocates argue there’s plenty of money in the system, and project the state would save $580 million annually by cutting out paperwork and insurance company profits.

“If we devoted all our health care dollars to actually taking care of people, we would save more than enough money to cover Vermonters who don’t have any insurance now,” said Earl Mongeon, a Communications Workers union member at IBM.

The Vermont bill could clash with the Obama plan, which doesn’t allow states to launch experiments until 2017. But Vermont’s best-known advocate of a single-payer system, independent Senator Bernie Sanders, told activists if they succeed, he’ll get a waiver.

In February, Obama said he would support a 2014 date for experimentation.

At the medical student rally, Bud Vana from the University of Vermont put on a green hard-hat to communicate to fellow students that “this is a work in progress.” He cautioned that results might be years off.

The obstacles are still immense. But, said Jonathan Kissam, “to be honest, I didn’t expect we’d get this far this quickly.”

A version of this article appeared in Labor Notes #386, May 2011. Don't miss an issue, subscribe today.


link (not verified) | 01/17/12

More specifically, home health care may include occupational and physical therapy, speech therapy, and even skilled nursing. It may involve helping the elderly with activities of daily living such as bathing, dressing, and eating. Or it may include assistance with cooking, cleaning, other housekeeping jobs, and monitoring one's daily regimen of prescription and over-the-counter medications.

dan (not verified) | 05/09/11

Which way forward for health care reform in America: Massachusetts or Vermont?
By Dan Lichtenstein-Boris, Southern California Conference Coordinator, California Health Professional Student Association

As the Washington insider crowd lauds and applauds Paul Ryan’s Medicare privatization scheme, the governor of Vermont is on the cusp of signing a state health insurance law that is cheap, nearly universal, and truly “courageous.”

In their new budget, Congressional Republicans used the national concern with cost containment to denounce Obama’s signature Affordable Care Act and its emphasis on patient access and the enhancement of quality care. Paul Ryan's Medicare Reform Plan and President Obama’s Patient Protection and Affordable Care Act of 2010 both promise to subsidize individuals to buy private insurance in regulated market exchanges. Neither idea, whether instituted for seniors or working adults, will dramatically reduce out of control medical price inflation. Rather than let individuals pick their insurance, Green Mountain Care, which is what they are calling Vermont’s quasi single payer, would let every Vermonter instead pick the provider of their choosing. Insuring all Vermont citizens and consolidating administrative costs will eliminate the inefficiencies created by market pressures in health insurance.

Market solutions to health reform will fail to curb rising prices because only state intervention can stop the death spirals of higher costs, fewer enrollees, and sicker patients. Gathering the fragmenting and warring health plans and incorporating them into a single unified system can protect both individuals’ and the public’s health and wellbeing. Green Mountain Care will eliminate inefficient competition that has led to escalating price increases.

Currently private employer based health insurance plans have little to no incentive to control costs. They generate the most profits by pushing costs onto others and collecting premiums from the healthiest. Insurers push costs onto the sick in the form of higher deductibles and co-pays. By squeezing doctors and hospitals through price negotiations, health plans turn away from subsidizing the costs of caring for the uninsured. Rather than invest in preventive care, these plans would rather wait until sick workers retire—and become Medicare’s responsibility, or become too sick to work, and fall into Medicaid’s purview. In the private insurance market, experience rating, caps, co-pays, deductibles, utilization review, checking for pre-existing conditions, and rescinding plans of those who need them most have all been acceptable mechanisms for health plans to discourage those likely to use services from getting insurance. Insurers compete on price by limiting the number of providers in their network. Clearly, insurance competition does not give consumers what they want—access to quality health care.

But why has the health insurance market failed consumers? Shouldn’t markets for health insurance work like other markets, where buyers and sellers compete by optimally using resources to settle the price, quantity, and quality best suited for all? Not in this case. Health care isn’t a good that one can make an easy decision to forego if the price isn’t right. People will pay as much as they value their own lives for certain urgent procedures and vital medications. Because of efficiencies and economies of scale in insurance, health plans serve both the healthy and sick best when everyone is in the risk pool. Green Mountain Care will come close to giving those in Vermont all the efficiencies of a single insurer.

By covering almost everyone, Vermont’s new state health insurance plan will eliminate the perverse incentives to pass costs along to the next sucker in the health care industry, rather than focus on reducing costs through preventing illnesses and managing chronic conditions. This plan is a roadmap to a new system. It sets Vermont squarely on the path to give the state a Canadian style health system within the decade, especially once Federal waivers become available in 2017.

But in order for the hope and aspirations of the Vermont people to be sustained, Vermonters need vision and support from the Obama administration. States should get federal license to experiment with their health plans sooner than 2017, as long as they make certain commitments to vulnerable populations, access and quality. Green Mountain Care is not a true single payer system because they will need waivers to roll Medicare, the Affordable Care Act, Medicaid and other federal health subsidies into the funds for Green Mountain Care and other state initiatives.

Massachusetts, Vermont’s New England neighbor, led the first charge to health reform this decade—individual mandates and market based health insurance exchanges. The verdict is still out on the fate of the Massachusetts model, but initial studies have shown that there has been little change to the amount of medical bankruptcies in the state. If we go by international evidence, a single payer plan will do a better job at containing costs and increasing access than a Massachusetts plan. The fact that Vermont’s Green Mountain Care is nearly a single payer plan truly frightens the opponents of social insurance. Hopefully, single payer supporters will finally have their platform in Vermont to show the country that single payer can work in America.

bob4healthcare (not verified) | 05/01/11

Side-by-side comparisons related to Improved Medicare for All via single-payer health care: - Original Medicare, Improved Medicare for All (hint: we want the latter!) - benefits -- current health insurance, improved mforall - why we'll have the best: current vs. improved mforall
. . . with references to other free-market countries - U.S. law, improved mforall - MA law, U.S. law, improved mforall

Chart comparisons:

Testimonials and opinions:

All three bureaucracies::

- Bob the Health and Health Care Advocate

bob4healthcare (not verified) | 05/02/11

To: Megan

Yes, it should be for all. As a general statement based on many people's experiences around the world, health care is simply provided.

Please note that the root cause for why health care is unaffordable is the whole bunch of us: individual Americans within the United States who have not taken the time and energy to inform other Americans of Improved Medicare for All (single-payer) Basics: facts and opinions about the subject. When we do inform Americans, we'll get it. On national conference calls during the last two years or so, single-payer activists from multiple states communicated that very few people know ... about single-payer. If people don't know what it is ... or have heard negative things about single-payer ... then I suggest that we focus on helping people know the benefits of implementing single-payer so that they can look forward to it.

Side-by-side comparisons related to Improved Medicare for All via single-payer health care:

Chart comparisons:

Testimonials and opinions:

People, in general, like to hear the positive about a possible change in our society. It's best to state what we'd like to achieve rather than focus on what we'd like to eliminate or on who is causing the problem(s).

Those organizations are not the complete source of the problem anyway.
Check out all three bureaucracies:

In addition to informing other Americans, we need to provide good, solid answers to their questions and concerns.

- Bob the Health and Health Care Advocate

P.S. Megan, there has been quite an element across the country in what I would call the "negative approach" to activism to get Improved Medicare for All. My suggestion to everyone interested in single-payer is to have a "positive approach" to help get it.

Megan Cornish (not verified) | 04/28/11

To Newslady:
U.S. Healthcare is unaffordable because it is based on private profits for healthcare corporations, insurance companies and big pharma, not because it is inherently exorbitant. Healthcare IS a human right, and as such should be available to everyone.

It also should be universal because that is the safest for public health. Otherwise, those who have no healthcare may not go to the Dr. when they come down with contagious diseases that then spread faster to everyone.

Finally, it is especially unjust to try to keep immigrant workers from getting it, when it was the Vermont Workers Center that did the public service of starting the campaign in the first place! Recent immigrants who are forced to come here illegally, generally do so because their livelihoods have been destroyed by NAFTA and other free trade agreements pushed by U.S. corporate power. Let's not scapegoat the victims, but hold the perpetrators responsible!

Newslady (not verified) | 04/27/11

I am from WI, not VT, but this section of the story, "In the Senate, a poison pill was added in the eleventh hour: undocumented workers would be excluded from coverage. “Farmworkers need health care, too,” said James Haslam of the Vermont Workers Center. “We are not Arizona!”

Many undocumented immigrants work year-round in Vermont’s dairy industry, as well as during the state’s short harvest season. Vermont Workers Center activists said that if the language stayed in, it would be the first time Vermont had officially discriminated against people on the basis of their immigration status. They vowed to fight the provision when House and Senate members meet to reconcile their versions next week." caught my eye.

Why give health care, which is almost un-affordable for citizens, to UNdocumented workers? Maybe it could be stipulated to make it only available for EMERGENCY health care for those workers?