VERMONT: Winning the Health Care Affordability Act
"Health care costs are rising; access to affordable insurance is limited; and our health care system is not designed to promote wellness, manage chronic conditions, or provide consumers with information to make informed decisions." That dismal assessment of health care in Vermont was made by the Jim Douglas administration on the eve of an epic battle for reform.
The Situation
In 2005, Coalition 21, an independent forum of respected leaders from government, labor, business and the health care sector, reached consensus over a set of principles to guild their state in developing a plan for universal health care. When the House Committee on Health Care met, they tacked the six Coalition principles on their wall as a constant reminder of the standards they needed to apply. After several months, the legislature passed their bill, all the principles intact. Then Republican Gov. Jim Douglas vetoed it.
A group of Vermont health care reform activists invited America's Agenda to meet with them to help decide on next steps. Executive Director Mark Blum observed: "The problem was basic. The bill that passed the legislature did not have the support of a broad-based campaign of working people and business leaders who could build political pressure on their elected officials." Without such a campaign, Vermonters had no effective way to deliver consequences to a governor who stood with the insurance industry to veto a bill most of them wanted. "To deliver consequences, you have to build a campaign," said Blum.
The Strategy
And build a campaign they did. Vermont NEA, AARP-Vermont and a score of other state-wide organizations that included the state AFL-CIO and Vermont Businesses for Social Responsibility, founded the Vermont Campaign for Health Care Security. "All of us understood the moral and economic imperative of winning the right to affordable, high quality health care for every Vermonter," said Vermont NEA's Mark Hage, who had a lead role in coordinating the campaign. "But now we are developing the capacity to organize effective support in our communities, in our workplaces, and in the State House."
Six of Vermont's seven town and city mayors joined the campaign in a press conference calling on the legislature and governor to adopt effective reform legislation and relieve municipal governments of the crushing burden of spiraling health insurance costs.
America's Agenda also arranged for Vermont legislators to have the financial guidance of respected health care economist Dr. Ken Thorpe. As the Burlington Free Press reported, Thorpe "steered the debate away from the politically charged question of how to pay for changes toward a more constructive discussion of how to deliver better and more cost-effective care."
With landmark legislation almost in reach, Gov. Douglas let it be known he wasn't happy with the bill and would likely veto it. Only this time, there was a campaign in place that could mobilize communities and constituents to action. Douglas is a popular governor, but polls showed his approval rating falling sharply after a broadcast and print media campaign produced by "America's Agenda" challenged his initial refusal to sign the reform bill.
"The media campaign did not so much move public opinion on the issue as articulate the values and anxieties Vermonters already held," said Blum. "All indications from public meetings to opinion polls pointed in the same direction. Vermonters wanted reform that would assure comprehensive health care coverage at a cost every Vermonter could afford. Voters were growing increasingly resentful of the obstructionism they were seeing from their governor after legislators from both parties had agreed to the kind of reform they wanted."
The Result
In late spring of 2006, the Vermont legislature approved the most far-reaching health care reform law enacted by any state in the last three decades. The Rutland Herald noted that the Health Care Affordability Act "is broader in its impact than other reform efforts nationwide because in addition to increasing insurance coverage, it establishes programs to manage chronic care delivery."
"This is truly historic legislation," said Gregg Marchildon, state director of AARP Vermont.
The Health Care Affordability Act created Catamount Health to administer the major restructuring of Vermont's health care system. Key elements of Catamount health include:
Affordable, comprehensive and quality health care is now available for all Vermonters. Creation of a modern statewide integrated delivery system designed to provide quality care at better value to all Vermonters with a chronic illness. Cost containment measures in the bill have reduced health insurance costs for all Vermonters.
"America's Agenda has lent our campaign unfaltering support and counsel at every step, yet they have entrusted us Vermonters to make every decision. This is a strategic partnership we want to continue."
-- Mark Hage, Vermont NEA
