Vermont's House passed a version of single payer health insurance legislation already passed by the state Senate last Friday. Vermont follows
California's House in adopting the most efficient way to provide universal coverage to its residents. One of the selling points for the "Obamacare" legislation just barely passed by Congress is that it contains a waiver mechanism allowing states to experiment with innovative methods of providing affordable health care. But it order to appease industry lobbyists, Congress delayed the implementation of opting out of the state exchanges until 2017, after the expense of establishing mandated state exchanges has been incurred. To opt out, states have to provide a system that provides comparable benefits to at least as many people as the exchange would have covered at no extra cost. Those requirements could be met without much difficulty by a state-wide single payer system because of its much lower administration costs. But states implementing innovative systems must also reconcile them with federal requirements for a host of federal programs: Medicare, Medicaid, FEHBP, Indian Health Service, Tricare, and ERISA that preempts legislation affecting employee benefit plans. HHS has no authority over ERISA, which is administered by the Department of Labor. Thus the new federal legislation
does very little to encourage states to adopt more efficient delivery systems for health. If California and Vermont implement single payer health insurance despite the regulatory hurdles, the rock will begin to roll.
