The timeline for the introduction of the single-payer plan stretches across seven years because of some federal waivers Vermont will need. Especially critical will be waiver request to replace the health benefit exchange required by the Affordable Care Act with a health insurance plan that could cover all 600,000 Vermont residents. The feds won't let Vermont apply for that waiver until 2015 and it won't go into effect until 2017.
Outterson, who also blogs about healthcare reform for The Incidental Economist, says Vermont officials are very aware that their progress in developing a single payer system is being closely watched by other states to see if the model really can hold down insurance costs. "Something the governor has done very well is to convince businesses to let this experiment go forward. His pitch is that if this works, Vermont will have the lowest healthcare costs in the country. That's a tremendous enticement for economic development in the state."