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.

ermont 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) On Tuesday the Vermont Senate passed a bill that activists hope will be a big stride towards health care for all. The House had already passed a similar bill.

Activists are dominating 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. They vowed to fight the provision when House and Senate members meet to reconcile their versions next week.

A big health care march is planned in Montpelier on Sunday, May 1. Fifteen hundred marched last year, and activists are heavily pressuring legislators. “We need to move forward now,” the Vermont Workers Center told supporters. “We will not accept excuses any longer.”

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.

SINGLE PAYER = ONE PUBLIC FUND

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.

‘NO CHANCE’

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.

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.

NOT A SYSTEM

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.

EMPLOYER RESISTANCE

“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 VOTES NO

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.”