MONTPELIER, Vt.—Every Vermonter could sign up for state-financed health insurance under a bill passed by the House on Thursday that would put the state on a path to a single-payer health care system by the middle of this decade.
"This bill takes our state one step closer to a system that ensures that all Vermonters have access to the care they deserve and contains costs," House Speaker Shap Smith said shortly after the House passed the bill 92-49.
The measure now goes to the Senate, where it is expected to pass, but with some possible changes.
Gov. Peter Shumlin, who made single-payer health care a centerpiece of his gubernatorial campaign last year, also praised the legislation. He said it would make Vermont "the first state in the country to make the first substantive step to deliver a health care system where health care will be a right and not a privilege, where health care will follow the individual, not be a requirement of the employer, and where we'll have an affordable system that contains costs."
Costs are an open question. The bill sets up a five-member state board to design a benefit package to be called Green Mountain Care, but doesn't require the governor to propose a way to pay for it until 2013. That drew fire from minority Republicans in the House, who said the hard part of reform -- paying for it -- won't be tackled until after Shumlin campaigns for a second two-year term in 2012. They also said the bill would create too much uncertainty for businesses in the state.
"Creating a health care system based on theory and campaign promises is not good policy," said House Minority Leader Don Turner, R-Milton.
Rep. Thomas Burditt, R-West Rutland, went further, arguing that government should sharply reduce, not increase, its role in the delivery of health care.
Burditt quoted V.I. Lenin, leader of the Russian Revolution and founder of the Soviet Communist Party, as saying "medicine is the keystone in the arch of socialism," adding, "I believe those who are promoting 'universal coverage' via government-run and government-controlled medicine know this. What they hope is that the public won't find out the truth. There is nothing compassionate about socialism. "
That drew a rebuke from Rep. Paul Poirier, I-Barre, a supporter of the bill. "I take offense at the remarks ... that we're socialists, that we're communists," he said. "I ask all members to respect other people's points of view."
Poirier spoke of profit-driven insurance companies denying coverage to people who should have it had coming, and, before Vermont passed laws to bar the practice, "cherry-picking" young and healthy subscribers who would pay into their coffers without being costly to cover.
Despite the Republicans' complaints, majority Democrats largely held together with their leadership to pass the bill. A similar outcome is expected in the Senate, though that chamber's president pro tem, Sen. John Campbell, said members would do their "due diligence" on the bill and might seek some changes.
The bill outlines a four-year timeline leading to establishment of the statewide, publicly funded system. It begins by setting up the Green Mountain Care Board on July 1 with a budget of $1.2 million to begin planning the new system. It then creates a health insurance marketplace -- or "exchange," of the sort required by last year's federal health care legislation. And it then calls for converting the exchange to the Green Mountain Care system.
The Shumlin administration and supporters of the bill need to address numerous uncertainties as the process goes forward. One concerns the more than 100,000 Vermonters who get health coverage from employers who are self-insured, meaning they assume the financial risks of coverage, and are chartered under federal law.
The House defeated a proposed amendment to allow those employers, among them the state's largest, like