Passing a single-payer healthcare bill is a top priority for many new Democratic state lawmakers. If they succeed, New York would be the first state in the country to switch to a universal coverage plan. But other states that have tried ultimately failed, leaving even some supporters questioning whether it could be done on a state level.
"Healthcare should be a basic right for all Americans. You should not have to make choices between healthcare, staying healthy and feeding your kids,” said former three-term Vermont Governor Peter Shumlin.
Shortly after Shumlin took office in 2011, he made good on a campaign promise and signed Act 48 into law. The landmark legislation was to create a government-funded single-payer healthcare system for all residents in the Green Mountain State.
Overwhelmingly popular across the state at first, single-payer healthcare had especially strong backing from members of Vermont's clergy like Rev. Peter Cook.
“I was very interested, as were a lot of other pastors, in how the economic burden could be alleviated,” Cook said, who is now the executive director of the New York State Council of Churches. “It just really struck me that we were paying far too much for the care that we were getting and a lot of people were not able to access that care.”
As CEO of the Vermont Association of Hospitals and Health Systems, Bea Grause watched the debate over shifting from private to public very closely. Originally an emergency department nurse, she's since signed on as president of the Healthcare Association of New York State.
“Healthcare is almost 20 percent of the economy — there are many, many different moving pieces,” said Grause. “The question of whether we should publicly finance healthcare or not it turned out not to be the most important question. The most important question was what are we going to publicly finance?"
From the get-go, Grause and others say Act 48 faced several key challenges that eroded its popularity.
Unlike the New York State of Health website, which has been widely praised, the rollout of Vermont's then new healthcare exchange wasn't as smooth.
“It was a disaster and it really caused a decrease in confidence in the government’s ability to actually implement something greater than that,” Gause said.
Implementation of the system also moved slower than many hoped, allowing opponents who viewed the single-payer movement as too costly to dominate the debate.
"By the time it finally did come out, the opposition had already really taken charge of the narrative,” Cook said.
By the time of 2014 election cycle, which led to Shumlin's third and final two-year term as governor, single-payer's popularity was at its lowest level in Vermont.
A subsequent economic report that showed businesses would see taxes increase by 11 percent or more each year sealed the movement's fate and Shumlin pulled the plug.
"It was the biggest disappointment of my governorship,” Shumlin said in a recent interview with Spectrum News. "I was honest with Vermonters, it was not very popular but I said, ‘Listen, we still have costs that are rising faster than we all can afford.’"
Despite the roadblocks that lay ahead, proponents of single-payer believe New York lawmakers can learn from Vermont's journey as they debate the issue here in Albany.
“Do not let the advocates tell you that it did not work in Vermont so therefore it will not work in New York,” Cook advised.
Before moving to single-payer, Shumlin believes the first step needs to be changing the private system's fee structure to get rising healthcare costs under control.
The New York Care Act, the current proposal before the state legislature, calls for more than $130 billion in new taxes.
"When you move from premiums to taxes, you cannot have the cost curve going up 10, 20 or 30 percent a year because politicians will not vote to raise taxes at that level,” Shumlin said.
Cook is optimistic New York lawmakers will do a better job marketing and explaining the nuances of the plan than their Vermont counterparts did.
"While they made a moral case this was really a good idea, they weren’t really making economic case as best as they could,” said Cook.
Grause's organization, HANYS, is not in favor of a single-payer system, but they believe other measures like increasing state subsidies can provide insurance to the 5 percent of New Yorkers — more than 1 million people — who don't currently have it.
“Let’s have the conversation, let’s absolutely talk about it. That was our approach in Vermont and I think really it hasn’t changed,” Grause said.
While Cook is more hopeful than the others New York Can be successful on its own, all three agree installing a single-payer system at the state level will be a challenge without the federal government's cooperation.
“The federal government right now is not terribly friendly toward the idea of single-payer,” said Cook.
"Let’s be honest about this, as long as President Trump is president of the United States, no state is going to be doing single-payer,” added the former governor.
While it may be decades down the road, Shumlin believes and hopes it will be the federal government that accomplishes the goal of providing affordable healthcare for all Americans.
"This is a huge problem for our economy — we've got to fix it,” he said.