As we previously reported, the Vermont legislature, led by Gov. Peter Shumlin (D), has been considering a proposal to establish some sort of single payer health care system, where a single public insurer provides health insurance to all state residents, similar to the Medicare system for American seniors.

Last night, the Vermont House of Representatives debated and approved by a 92-49 a bill that would create a single payer system in the state. Shumlin praised the move as making Vermont the first state where “health care will be a right and not a privilege“:

After hours of debate, the Vermont House of Representatives approved a bill that would create a single-payer health care system in Vermont. It passed 92-49. In a meeting right after the vote, the house speaker, the governor and others who worked on the bill called it a historic moment for Vermont.

“Become the first state in the country to make the first substantive step to deliver a health care system where health care will be a right and not a privilege,” said Gov. Peter Shumlin.

The “bill outlines a four-year timeline leading to establishment of the statewide, publicly funded system. It begins by setting up the Green Mountain Care Board on July 1 with a budget of $1.2 million to begin planning the new system. It then creates a health insurance marketplace — or ‘exchange,’ of the sort required by last year’s federal health care legislation. And it then calls for converting the exchange to the Green Mountain Care system.”

Now that it has passed the House of Representatives, it will move on to the Senate, where it is expected to pass. A bigger hurdle Vermont faces is obtaining a waiver from the federal health care reform act and finding a way around federal ERISA laws — which “pre-empt states from enacting legislation if it is ‘related to’ employee benefit plans — that insurers could use to sue the state. The health reform law currently offers a waiver to states who meet certain standards by 2017; Rep. Peter Welch (D-VT) has introduced an amendment that would move the waiver date up to 2014 — an idea that President Obama has endorsed.

This week, 200 doctors from 39 states including the District of Columbia signed an open letter saying they would seriously consider moving to the state to practice medicine if it enacted a single payer system. “The idea of having one set of rules, one form for billing, and knowing that all patients are covered – that would be wonderful,” said Scott Graham, a Kentucky family physician who signed the letter.

As we previously reported, the Vermont legislature is currently considering a proposal that would pave the way for the state to enact a single payer health care system. While the proposal’s authors found that the state would be able to offer more comprehensive health care and save more money than the recently-passed federal health care law if it were to enact single payer, it is important to note that under current law the state cannot request a waiver to be exempted from the federal health law until 2017.

To counter this, Vermont’s congressional delegation is backing an amendment by Rep. Peter Welch (D-VT) that would move the waiver date up from 2017 to 2014. Earlier this week, Reps. Jim McDermott (D-WA) and Jan Schawkowsky (D-IL) told ThinkProgress that they support Welch’s amendment; additionally, Reps. James Clyburn (D-SC) and Rosa DeLauro (D-CT) appeared to support the principle behind the amendment.

Today, Vermont governor Peter Shumlin (D), who supports the single-payer proposal, appeared on Democracy Now! to talk about his plans to enact it. He explained that he would like to build a bipartisan coalition under the principle of local control and state’s rights to get the waiver date moved up, and told Goodman that, by requesting a change in the waiver, Vermont was not “asking for one additional federal dollar.” Rather, the state is asking to be “able to pool our federal dollars into our existing system here in Vermont, in a uniform system. And I think that will appeal, frankly, to more conservative members of the Republican Congress.” “Give us local control,” he continued. “I think that will appeal to, frankly, some of the Tea Party governors that I have just been elected with”:

AMY GOODMAN: Governor Shumlin, why doesn’t it conflict with Obama’s healthcare proposal? What are the waivers you would need?

GOV. PETER SHUMLIN: Well, the biggest waiver we need—and, you know, we have an incredible congressional delegation, Senator Leahy, Senator Sanders and Representative Welch—but the biggest waiver we need is to ensure that by 2014 we can get the waivers that we need to implement this plan. And really what we want to do is—we’re not asking for one additional federal dollar. All we’re asking is that we are able to pool our federal dollars into our existing system here in Vermont in a uniform system. And I think that will appeal, frankly, to more conservative members of the Republican Congress. What we’re saying is, give us local control. Let us go our own way. We’re not asking for more federal dollars than any other state. What we are asking is that you let state rights stand up and let us design our own system, using those federal dollars as we see fit. And I think that will appeal to, frankly, some of the Tea Party governors that I have just been elected with.

Watch it:

Vermont Digger asked Leigh Tofferi, a Blue Cross-Blue Shield lobbyist based in the state, about the possible move to a single payer system. “If there’s a single payer system, we’d like to be the single payer,” she replied. Harvard’s Dr. William Tsiao, who helped design the Taiwanese single payer system and was one of the consultants responsible for drafting Vermont’s single payer proposal, noted that private insurance companies could continue to play a role in a single payer system by providing supplementary insurance, much like they do with Medicare. However, he also warned that instead of working with reformers, insurers could also use their “deep pockets nationally [to] oppose reforms due to the threats they pose to the Vermont market and other markets that could follow Vermont’s lead.”

Yesterday, as House Republicans voted to repeal the Affordable Care Act, the Vermont legislature heard a proposal for how to move the state to a single-payer system. The report, organized by Bill Hsiao, a professor at the Harvard School of Public Health, would provide insurance to everyone with a common benefit package that would pay at least “87 percent of each Vermonter’s medical and mental health expenses and 77 percent of his or her drug expenses” and channel all the payments to doctors and hospitals “through a single pipe.”

The “pipe,” so to speak, is an Independent Board representing “all the major payers, including, employers, state government and consumers, as well as the beneficiaries or recipients of benefits and payments, including providers and consumer groups.” The board would “negotiate updates to the benefit packages and payment rates to providers,” but outsource all claims administration and provider relations work to a private company. This kind of approach, Hsiao estimates, would create savings that would outpace those of reform, producing savings of “approximately $590 in 2010 US Dollar real terms“:

Specifically, in 2015 project that the cost would decrease by approximately 11% of what they would be under PPACA….Under those savings assumptions, total health care costs in 2015 would reach approximately $5.776 billion in real 2010 dollars, $500 million less than under implementation of PPACA. On a per capita basis, total expenditures would be $8,580 in 2015, or about $750 than under PPACA. The savings would reach about $1.2 billion in 2019. By that year, the total per capita expenditures would increase to $8,800, representing a per capita savings of about $1,800 compared to PPACA.

The plan would be financed through a higher payroll tax on employees and their workers, but Hsiao estimates that the tax burden would be “less than what they are paying in premiums now.” Premiums costs could further be lowered through payment and malpractice reform. Private insurers, meanwhile, will their role greatly reduced, but not entirely eliminated. The report indicates private companies could sell “supplementary insurance” that provides greater coverage than the common benefits package.

Hsiao said that Vermont faced “no fewer than 15 hurdles before it would be able to implement the plan,” not the least of which are some of the new requirements and regulations in the Affordable Care Act. The Vermont Congressional delegation has introduced an amendment that would expand a provision in the law that allows states to propose their own pilot health care programs and seek a waiver from the federal health care law so that they can pursue their own approaches to health care reform. The current law allows states to pursue these waivers in 2017; the amendment would move this waiver date up to 2014. A companion measure has also been introduced by Sens. Ron Wyden (D-OR) and Scott Brown (R-MA) in the Senate, but it remains to be seen how cooperative HHS will be in granting waiver and allowing the state to pursue these reforms.