The Affordable Care Act aka “ObamaCare” permits states to experiment in creating their own health care systems that are at least equal to the federal system in coverage and benefits.
In 2011 the state of Vermont, with a population of less than the City of Tucson, was the first state to enact a single-payer health care law in the United States, known as Green Mountain Care. Private insurers were allowed to continue to operate in the state.
The Vermont experiment with a single-payer health care system did not come to fruition. Governor Peter Shumlin abandoned Vermont’s single-payer health care system in December 2014. Governor abandons single-payer health care plan:
Calling it the biggest disappointment of his career, Gov. Peter Shumlin said Wednesday he was abandoning plans to make Vermont the first state in the country with a universal, publicly funded health care system.
Going forward with a project four years in the making would require tax increases too big for the state to absorb, Shumlin said. The measure had been the centerpiece of the Democratic governor’s agenda and was watched and rooted for by single-payer health care supporters around the country.
“I am not going (to) undermine the hope of achieving critically important health care reforms for this state by pushing prematurely for single payer when it is not the right time for Vermont,” Shumlin said to reporters and two boards advising him on health care changes.
Legislation Shumlin signed in 2011 put the state on a path to move beyond the federal Affordable Care Act by 2017 to a health care system more similar to that in neighboring Canada. Shumlin adopted the mantra that access to quality health care should be “a right and not a privilege.”
The legislation called for the administration to produce a plan for financing the Green Mountain Care system by 2013 but it wasn’t completed until the last several days. Shumlin said it showed the plan would require an 11.5 percent payroll tax on businesses and an income tax separate from the one the state already has of up to 9.5 percent.
Shumlin said small business owners would be hit with both, and he repeatedly expressed concern about whether those businesses, many of which now don’t offer health insurance or offer much less costly insurance, could cover the new expense.
“The bottom line is that, as we completed the financing modeling in the last several days, it became clear that the risk of economic shock is too high at this time to offer a plan I can responsibly support for passage in the Legislature,” the governor said.
Sarah Kliff at Vox.com has more on How Vermont’s single-payer health care dream fell apart.
But a little less than a year later, the citizens of the state of Colorado have successfully qualified a citizens initiative for a single-payer health care system for the 2016 ballot, seeking to make Colorado the first state to successfully implement a single-payer health care system.
The Denver Post reports, Colorado to vote on single-payer state health-care system:
Proponents of a single-payer state system gathered enough signatures to put ColoradoCare on the ballot, the secretary of state’s office announced Monday.
They needed 98,492 valid signatures to put a state-governed health care system to a vote. After reviewing a 5 percent sample of the 158,831 signatures submitted, the secretary of state projected that the valid total would be 110 percent of the number required — and certified that Initiative 20, the “State Health Care System,” will be on the 2016 ballot.
Residents would choose their own health care providers, but ColoradoCare would pay the bills.
The measure is likely to ignite a fiery debate because of the costs involved. Backers estimate ColoradoCare would raise $25 billion a year for health-care costs through a proposed 10 percent payroll tax. Critics decry it as a massive expansion of government that would double the size of the state budget.
“We’re all excited. This is really important for the people of Colorado,” said Ivan Miller, executive director of ColoradoCare YES and head of the Colorado Foundation for Universal Health Care.
“Gathering signatures is really tough. I think the political consensus was we didn’t have a prayer.”
Miller, a psychologist and author of a book on health-care reform, contends that if the initiative passes, residents will gain premium health care coverage for $5 billion less than they pay now. ColoradoCare would slash administrative costs of private insurance and negotiate bulk rates for pharmaceuticals.
The coverage would extend to “anybody who earns income and lives in Colorado,” he said.
The initiative calls for a 21-member governing board from seven regions of the state. Its first members would be appointed by the governor and legislative leaders, but an elected board would succeed them.
Miller said the board could use any excess revenues to pay refunds or enlarge benefits, but it could not raise the payroll tax without voter approval.
Opponents call ColoradoCare a gamble that would send Colorado down a path no other state has tried.
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Colorado Hospital Association spokeswoman Cara Welch said the hospitals have not taken a formal position yet, noting that the initiative just qualified for the ballot.
Rick Ridder, a veteran Colorado campaign consultant, said he expects opponents of the initiative to raise more money, but the biggest spenders don’t always win.
“I think the key piece is whether the proponents are able to communicate the benefits” in comparison with the tax increase, he said. “That’s the crux. If you’re able to communicate the benefits to the citizens, you can win.”
Under the proposed system, people could still choose their medical providers, but the bills would be paid by ColoradoCare instead of private insurance companies.
To pay for state coverage, employers would pay 6.67 percent in payroll taxes and employees would kick in 3.33 percent, for a total of 10 percent of the payroll. Self-employed people would pay 10 percent of their net income. People who qualify for existing federal health programs could continue to receive the same benefits.
If ColoradoCare passes, the state would apply for a waiver from the Affordable Care Act. Colorado would also have the first statewide universal health care system in the country.
“Colorado deserves a better option, and now they can vote on one,” said state Sen. Irene Aguilar, D-Denver, a medical doctor who has championed universal health care. “Health care costs continue to rise every year, hurting Coloradans’ chances to get ahead. It’s time we get the insurance industry out of the driver’s seat and put families in charge of their health care.”