MONTPELIER -- The Vermont House of Representatives passed a bill calling for a single-payer system Thursday afternoon, putting the state on a path to become the first in the nation to adopt universal access to health care.
Lawmakers voted 92 to 49 after nearly two days of debate, including discussion on the floor until the early morning hours on Thursday.
Advocates hail the measure as the solution to control costs by reducing administrative overhead. However, critics said it leaves too much financial uncertainty and could hurt the economic growth in Vermont.
The legislation proposes to develop a unified health system where all Vermonters are eligible for benefits under a universal coverage program called Green Mountain Care. Democratic leaders are optimistic the single-payer plan will contain the skyrocketing costs of health care and put the state on a more sustainable fiscal path.
"I think that we all know, and there was universal agreement on the House floor, that the current system will bankrupt us. Costs of health care in Vermont are going up $1 million a day. They are $2 billion more than they were 10 years ago. We have a problem, we need to solve it," said House Speaker Shap Smith, D-Morrisville. "This is just the first step in the process. This will be a long road ahead, and we have much work left to do. But we have taken a bold step forward today."
The measure also designs a four-year timeframe to establish a publicly funded system, beginning with the creation of the Green Mountain Care Board on July 1 with a budget of $1.2 million. The five-member board will design a more sensible payment plan for health care providers, control the overall cost to align it closer to Vermonters’ ability to pay and recommend a benefit package for every resident.
However, the bill does not require the governor to propose a payment plan for the single-payer system until 2013, which sparked outcry from House Republicans. Paying for the reform is the most controversial portion of the bill and it will not be addressed until Gov. Peter Shumlin campaigns for his second term next year.
Shumlin, the first-term Democrat who made health care reform a cornerstone of his gubernatorial campaign last year, said the House has moved Vermont in a historic direction toward fixing a broken system.
"This is a really important step for Vermont. If we want to create jobs, if we want to be the state that makes the difference in controlling health care costs so that we can grow jobs and economic opportunities ... this is an extraordinary moment," he said.
Thursday’s otherwise civil debate turned into a political war of words after Rep. Thomas Burditt, R-West Rutland, said promoting universal coverage is the "keystone in the arch of socialism," drawing criticism from Democrats and independents supporting the measure.
"I take offense at the remarks ... that we’re socialists, that we’re communists," said Rep. Paul Poirier, I-Barre. "I ask all members to respect other people’s points of view."
Cooler heads prevailed as lawmakers wrapped up the roll call vote shortly after 3 p.m. The legislation heads to the Senate, where it is expected to pass with some possible changes.
Republican critics called on Senate members to "correct the errors" on the bill, particularly the cost burdens on state government.
Opponents said it is not feasible to implement a single-payer system as a stand-alone, suggesting instead an amendment to protect self-insured employers in the state. GOP lawmakers pressured their Democratic counterparts to listen to the hundreds of small businessowners voicing concerns over self-insurance.
"Risk and uncertainty are two barriers to economic growth and this promise would help alleviate these concerns," said Rep. Oliver Olsen, R-Jamaica. "Self-insured businesses represent nearly 20 percent of all employers in Vermont, which is a large portion of our economy, and they are worried about how this bill will affect their ability to do business in Vermont."
The amendment, proposed by Stowe Republican Heidi Scheuerman, was soundly defeated.
Rep. Michael Hebert, R-Vernon, spoke from the floor about his issues with the uncertain cost of such a health care network.
"I have a tremendous number of questions. And I’m not in opposition to health care finance reform, I’m just in opposition of us going down a road where we don’t know what it costs," he said. "There are just so many unanswered questions and I’m really concerned with this five-member board. They’re going to have the authority to rule on every aspect of our health care in the state of Vermont."
Meanwhile, Democrats hailed the swift-moving bill as a vote for hope and not fear. Supporters hugged outside the House chamber following the passage, a sense of pride on their faces as they praised the landmark health care measure.
"Today, Vermont’s House of Representatives showed America our small state has both the courage and conviction to lead the way nationwide on the creation of a unified single-payer health care system," said Rep. Valerie Stuart, D-Brattleboro. "I thank the members of the [House Health Care] committee that created this piece of legislation with all my heart."
The benefits under Green Mountain Care would not take effect until after Vermont receives a federal waiver under the Patient Protection and Affordable Care Act of 2010. By 2014, the bill established a health care exchange as required by federal law.