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How Vermont Got a Single-Payer Health Care Bill: A Non-Electoral History

This is a crucial year in Vermont’s fight to enact its single-payer health care law, with design and financing in the works, and while progressives are credited, that narrative obscures how citizens of all stripes forced their elected officials to act.

A Progressive Party sign in the Burlington Mardi Gras in Vermont, February, 2007. (Photo: Rob Friesel)

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In May of 2011, while the nation feuded over Obama’s ACA, Governor Peter Shumlin signed Act 48 into law, and Vermont became the first state to enact single-payer health care.

The legislation sent a jolt throughout the nation, inspiring organizers in a number of states to take Vermont’s lead and fight for universal health care access in their own communities. This year is an important moment in the process, as a financing plan is being developed and is scheduled to be passed in 2015. With corporate forces – and moneyed interests – looking to dismantle the state’s victories, the struggle will continue as Vermont moves to make the plan operational in 2017.

Most mainstream commentary on “Green Mountain Care” has tended to focus on the progressive politics of the state’s leaders. The Atlantic reported that it was, “the culmination of decades of work by progressive politicians in the state.” There was also, predictably, a fair amount of talk about Bernie Sanders, Vermont’s popular progressive Senator, who had been advocating for a single-payer system for decades.

“I am very proud that my home state of Vermont is now taking big steps to lead the nation in health care by moving forward on a plan to establish a single payer health-care system that puts the interests of patients over chasing profits,” Sanders wrote after Act 48 passed, in a Guardian piece. In the most surprising of moves, The New York Times (preferred paper of liberals who still blame Bush’s election on Ralph Nader) ran an op-ed by Molly Worthen, saying a great many nice things about Vermont’s most popular third party. “Mr. Shumlin is a Democrat, and the bill’s passage is a credit to his party,” wrote Worthen, “Yet a small upstart spent years building support for reform and nudging the Democrats left: the Vermont Progressive Party.”

Worthen’s right. Vermont’s Progressive Party was a – tremendously – important part of the health care fight and should garnish more national attention. Vermont’s Progressive Party used its leverage to help push Shumlin toward his position. However, to view what Vermont did through the lens of electoral politics is to miss the much bigger story.

The starting point to zoom in on isn’t Shumlin’s legislation, or even Shumlin’s election. A better spot is 2007, when the idea of single-payer seemed too big of a goal, a concept that would never possess the level of political capital needed to get it off the ground. When organizers initially sat down with Shumlin, he parroted these same concerns, explaining that the window didn’t exist yet; many local organizations agreed. “A lot of big, mainstream groups were advocating incremental steps, while not addressing the roots of the problem,” James Haslam, the director of Vermont Workers’ Center, a vital grassroots network started in 1998, told Truthout. “About 7 years ago, we made a conscious decision to respectfully walk away from that process and do it on our own.”

Doing it on their own way didn’t, initially, begin by pressuring politicians. It simply began with a basic premise: Health care is a human right that everyone deserves. Organizers spent months bringing their message to the people of Vermont and collecting stories from residents who lacked insurance.

“When my employment status changed, figuring out how to have access to health insurance was a huge ordeal filled with hurdles which became a full-time job,” Brattleboro resident Ellen Schwartz said in one of the campaign’s reports, “I spent a lot of time filling in paperwork and essentially navigating a complicated bureaucracy. This bureaucracy is based on the idea that you have to qualify for this, that or the other program or service. So then we need all these gatekeepers to make sure the wrong people don’t get through the gate, or that people don’t get medical services they aren’t ‘eligible’ for.”

HCHRC (Healthcare is a Human Right Campaign) was based on five key principles: Universality, Equity, Accountability, Transparency, and Participation.

These personal stories from citizens constructed the backbone of the campaign, which was spearheaded by the Vermont Workers’ Center and sustained by thousands of people throughout the state. There’s a narrative, floated out regularly in coverage of this story, which suggests that the state’s accomplishments are merely a byproduct of Vermont’s left-wing population. It’s easier to obtain health care, this logic goes, if your state is full of hippies and college students. However, this perception of Vermont isn’t entirely true. While a city like Burlington might contain a number of people naturally receptive to the idea of universal health care, the stereotype begins to break down beyond the more urban areas. Vermont elected Republican governors from 1854 to 1963, and that element still, very much, exists in the state. Haslam’s description of the organizing work that was done in conservative areas of the state is somewhat in line with the thesis of Thomas Frank’s 2004 book, What’s the Matter With Kansas? where Frank theorizes why formerly populist regions of the country have fallen to conservatives. “We went into areas that progressives had given up on,” Haslam told me. “People didn’t think they could win.”

The inclusive message had the effect of expanding their base: Organizers working on immigrant rights issues and disability rights groups joined the battle for single-payer.

His analysis directly contradicts the idea that Vermont was predisposed for health care legislation. Jake Williams, who helped organize with the Healthcare is a Human Right Campaign (HCHRC) in 2010, explained to Truthout that, “While there were already a good number of true believers in single-payer in Vermont, [we] essentially mobilized the grassroots support that helped pass the legislation, which also diversified the single-payer base from well-off lefties to a general cross-section more representative of the state’s populace. The campaign grew out of a large, statewide survey . . . all signs pointed to healthcare being a primary concern for most Vermonters.”

Organizers also discovered that support for policy often shifted based on how the issue was framed. Ask a person if they believe everyone has a right to health care, they might say no. But, then, ask them which member of their family they’d be prepared to take insurance away from, and their position might, naturally, become a bit different.

Vermont’s clear commitment to universal principles stood in sharp contrast to the, infamously flawed, Affordable Care Act sell. HCHRC was based on five key principles: Universality, Equity, Accountability, Transparency, and Participation. The ideology of the organizers, and the basis behind their efforts, was nearly impossible to muddle. Additionally, single-payer advocates refused to go on the defensive or dumb down their message in the name of political feasibility.

When confronted with concerns about undocumented workers potentially receiving coverage, organizers didn’t concede the point: They began anti-racist training sessions to develop new ways to combat the xenophobic attitudes some of their critics held. This, perhaps, wouldn’t have been the approach adopted by the mainstream organizations they chose to walk away from in 2007, but the inclusive message had the effect of expanding their base: Organizers working on immigrant rights issues and disability rights groups joined the battle for single-payer. It would be hard to imagine the movement growing if activists had taken a more politically cautious tact, contorting their demands to the parameters of their opposition, and becoming lost in banal statistical digressions.

“There must be a means to hold government accountable for failing to meet human rights standards,” Nadene Wetherby, of Sheldon, declared during her testimony. It was a message that resonated with Vermont residents, regardless of their political identification. Some polls and studies conducted by the campaign, gauged support for single-payer at over 90 percent.

“All Vermonters must receive affordable and appropriate health care at the appropriate time in the appropriate setting and health care costs must be contained over time.”

The reasons behind these staggering numbers weren’t difficult to understand: In 2008, the state had spent nearly $5 million on health care, while thousands of people remained uninsured. By 2010, a year in which the state cracked the $5 million mark, Vermont’s fight had blossomed into an expansive movement that could not be slowed down, with massive statewide rallies drawing attention from progressive groups across the country. After years of talking to those negatively impacted by our for-profit health care system and establishing the necessary connections throughout the area, a legislative victory was realized in the form of Act. No. 128, a bill that required the state to establish a universal health care system.

Republican Governor Jim Douglas announced that he would not veto the bill. Act 128 established a commission, which was expected to hire an independent consultant to come up with a set of health care models. Dr. William Hsiao, a Harvard health economist, was selected. Hsiao had given up on the American health care system during the ’90s, after realizing that policies were principally driven by money. Now back, Hsiao inquired what principles the models should adhere to.

The legislature, driven by the commitment of its constituents, let Hsiao know that the system must, “ensure universal access to and coverage for essential health services for all Vermonters. All Vermonters must have access to comprehensive, quality health care. Systemic barriers must not prevent people from accessing necessary health care. All Vermonters must receive affordable and appropriate health care at the appropriate time in the appropriate setting and health care costs must be contained over time.”

With the governmental aspect of the fight kicked off, Vermonters took their stories directly to the state’s leaders, packing the statehouse to share the testimonies they had prepared, while dropping off a single-payer petition, which had been signed by over 4,000 residents.

Mardi Cordes, the president of the Vermont Federation of Nurses and Health Professionals, told the crowd that, “Today is day one in building a people’s movement to establish a universal health care system in Vermont and, by doing so, help lead the way to finally having universal health care in this country. We are here today because the health care system in Vermont is broken. Every week I hear about patients that are critically ill because they didn’t get help when they should have, some of them die. Many lose their homes and have to choose between treatment or food for the family . . . my own hospital is slashing necessary services, including preventative ones.”

Peter Shumlin had, narrowly, won the gubernatorial election of 2010, snagging 49.44 percent of the vote, while his Republican opponent got 47.69 percent. The Progressive Party agreed to sit out the election if Shumlin backed universal health care. “In the end Shumlin became [the Democrats’] candidate having campaigned on single payer,” Chris Pearson, Leader of the Vermont Progressive Party in the Vermont House of Representatives, told me, “He narrowly won . . . so it’s easy to assume that a Progressive running would have made his roughly 4,000-vote victory impossible.”

Elected with clear expectations, and a sizable campaign gripping the state, Shumlin, the man who had once told organizers health care wasn’t a plausible goal, began taking the necessary steps toward achieving single-payer and, in spring of 2011, Vermont saw its biggest health care victory yet. If everything goes according to plan, and the fight doesn’t let up, it shouldn’t remain their biggest.

“I would say that without the grassroots organizing to pressure the legislature, the bill would have continued to stall,” Jake Williams told Truthout. Yet, when Shumlin passed the health care bill, he didn’t bother thanking the Health Care is a Human Right Campaign, the Vermont Workers’ Center, or the many activists who had fought so hard. Members of the grassroots effort stood behind Shumlin at the press conference, but they were cropped out of the next day’s front page photos. They’re used to it.

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