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Single Payer: Please help draft a response to Governor Shumlin on the single payer waiver

We'll get to the draft below the fold; first we'll cover the correspondence leading up to it. First, our Vermont Correspondent wrote the following letter:

Dear Governor Shumlin:

I urge that Vermont seek an immediate waiver from ObamaCare instead of waiting until 2017.

A strong argument can be made, at this point in the ObamaCare fiasco that continues to play out, that Vermont should make an effort NOW to get out of the exchange and move straight to single payer. Why throw good money after bad and prolong Vermont's losses of life and money if it can possibly be avoided?

As I understand it, Vermont agreed to wait until 2017 to withdraw from the exchange in exchange for getting Federal funding to pay for more and better health insurance coverage for lower income people and to pay for the setting up of the exchange.

As the ObamaCare exchange proves unworkable--that is, Vermont has had to postpone aspects of the implementation and may have to postpone others for as long as a year--Vermont should be able to withdraw from it, without penalty, and devote our precious resources of time and money to implementing single payer ASAP.

Lives would be saved.

If you can point me to any reason(s) why this move cannot be undertaken now, or should not be, I'd appreciate it.



A Concerned Vermonter

And the Governor's office wrote back:

Dear Concerned Vermonter:

Thank you for writing to Governor Shumlin and expressing your support for a single payer health care system in Vermont. The governor shares your goal of implementing universal health care for all Vermonters at the earliest possible opportunity. As laid out in Vermont's Act 48 of 2011, we plan to obtain a federal waiver to implement our state reforms as soon as allowed under federal law. Section 1332 of the Patient Protection and Affordable Care Act allows for states to obtain waivers no earlier than 2017. When Act 48 was passed in 2011 there was the possibility that the Section 1332 waiver would be available sooner. Two bills were introduced to the 112th U.S. Congress to allow states to obtain waivers in 2014, but unfortunately they were unsuccessful.

The path to publicly financed, universally available, high quality health care coverage is complex and is being accomplished in several stages.Vermont Health Connect—Vermont's health benefit exchange—is a step in the right direction toward our ultimate goal of universal coverage for all Vermonters. The exchange is more than a website, it allows more Vermonters to access health coverage and receive financial assistance to help them pay for care. However, as you know, it is not the silver bullet that will bring our rising and unsustainable health care costs under control in the long run.That is why we continue our planning to implement the universal Green Mountain Care program called for in Act 48. The governor is committed to continuing our efforts to bring real health care reform to Vermont. We have a tremendous opportunity in Vermont to create jobs and economic opportunity by finally bringing costs under control—by paying for quality outcomes rather than for quantity of services.

Thank you again for adding your voice to discussion of health care reform in Vermont. Your feedback and concerns about today's system, including Vermont Health Connect, are extremely helpful and inform our efforts to move forward with reform.

Carolyn Wesley
Director of Constituent Services
Office of the Governor
109 State Street, Pavilion
Montpelier, Vermont 05609

Needless to say, that letter doesn't tell anybody who's been paying attention anything they don't already know. So here is the draft response, which, readers, is where we would like your feedback and help.

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Dear Carolyn:

Thank you very much for your response.

As I understand what you say here, Vermont will not be able to apply for a waiver until after President Obama's term has expired at the end of 2016. I am very concerned that 3 years down the line, perhaps with a different governor in office in Vermont who does not support the current plan, definitely without Obama in the White House, and perhaps with a Republican president and a more Republican-controlled Congress than exists now, Section 1332 might not survive the pressures of the moneyed powers who have clearly demonstrated their determination to keep the door closed to single payer care anywhere in the U.S. If I were they, I would be making every effort to prevent Vermont from moving ahead with single payer, and that would include the obvious move of cutting off the waiver.

Because (presumably) of those powers having effectively prevailed already, we have already failed to obtain the waiver when we tried hard (presumably) to get it. Instead, what we have got is a postponement of it so far down the road as to make us very vulnerable to the permanent forfeiture of the implementation of single payer universal health care in Vermont. What assurance can Governor Shumlin give me, and all Vermonters, that we will get the waiver when we seek it again--having failed to get it the first time we tried? I am not reassured by the fact that the ACA as passed by Congress guarantees the waiver--especially since all that Act merely guarantees that we are allowed to apply for it--as I am aware of how common it is for full enactment and enforcement of Congressional acts to fall short of the original mandate.

In view of the uncertainty I have just described, I do not understand why Vermont is not seeking proactively to get that waiver now. At the least, in the worst case scenario, we can say that we tried our damnedest. President Obama has adjusted the schedule of implementation for parts of the ACA since the October 1 launch so as to protect citizens and business owners from any bad consequences of the launch problems. The flexibility he has shown in taking these steps offers Vermont an opening to seek the waiver now. Can the Governor explain to me why this should not be done?

Thank you for your time and attention to my concern.


A Concerned Vermonter

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I think it's awesome that our Vermont Correspondent is doing this, and I encourage any other Vermonters, and any other readers in states where a single payer waiver is at issue, to follow their example. Maybe these letters can provide models!

So, readers, how would you revise the draft?

UPDATE Note that the new bill that Vermont Senator Bernie Sanders and Washington Representative Jim McDermott are sponsoring would allow states to "win approval to design and operate their own single-payer system." Assuming that there are hearings on the bill, as Senator sanders assured me there will be, it would seem to represent an effort toward a way for states that want to develop single payer, including Vermont, to extricate themselves from the ACA before 2017.

No votes yet


Submitted by hipparchia on

some minor nits to pick

in the letter:
1. remember to capitalize white house, congress, and any other capitalizations needed
2. consider using a more formal address in place of 'dear carolyn' - the original letter wasn't addressed to 'dear pete'

in the post:
1. turn off the biblegateway links

Submitted by hipparchia on

Any thoughts on substance?

no. i'm rabidly opposed to dismantling the national system we have now and replacing it with 50+ balkanized "healthcarefinancing-istans" so i confined my suggestions to small changes in appearance.

letsgetitdone's picture
Submitted by letsgetitdone on

it's very good,and doesn't need changes.

Splashoil's picture
Submitted by Splashoil on

Let's get as many Vermonters signed on this as possible! Like soul singer Charles Bradley says this is "No Time for Dreaming!" We don't need to wait for no stinking exchanges.