The Vermont Health Care Reform was established in 2011 after the state government passed a law allowing for a single-payer health care system. This created Green Mountain Care, a state-funded insurance pool providing universal coverage. However, it failed due to a lack of structured funding and political barriers. The complexity of establishing such a large reform demanded an effective funding structure and management system.

1. Running head: VERMONT HEALTH CARE REFORM
2
VERMONT HEALTH CARE REFORM
Vermont Health Care Reform
Yitsy Serrano
Health Care Policy
Florida National University
Vermont Health Care Reform
The Vermont Health Care Reform was established in 2011 after
the state government of Vermont enacted a law that allowed for
a single-payer system in the United States. This law established
a functional first-level single-payer health care system that has
since been embraced in other states within the United States of
America. The Green Mountain Care allows subscribers of
Vermont’s health care reform to receive universal care coverage
as well as upgrades to the existing system (William, 2010).
In 2010, the state of Vermont, under the provisions of S88 law
passed by the legislature, was allowed to form a commission to
study the health care provision and delivery techniques within
the state. In this quest, Dr. William Hsiao, a Harvard University
professor, who previously had been contracted to advise the
Taiwan’s commission during the transition to single-payer
system, was enlisted to provide three reform policies for the
Vermont health care system. On June, William alongside Steven
Kappel and Jonathan Gruber presented the single payer system
proposal to the legislature of Vermont.
Following the proposal, H202 was introduced by Senator Mark
Larson which the titles as Single-Payer and Unified Health
System. On March 24, 2011, the bill was passed with a 94
against 49. Consequently, the Senate passed the bill with a 21

2. against 9. The Governor, the Vermont State Peter Shumlin, then
signed the bill into law on the 26th of May 2011. The Green
Mountain Care then followed after the signing of the H202. This
was a state-funded insurance pool that was established to
provide universal care to residents with the aim of reducing
spending on health care.
It is important to note the Vermont Health Care Reform was
established without a structured framework of funding and this
is one of the reasons why it failed. The issue of paying for the
reform became an issue when the prospective bodies failed to
provide enough revenues to fund the program. The idea of
funding the program was to increase the Medicaid funding by
three percent and use the proceeds to set up the funding
infrastructure for the Vermont Health Care Reform.
Holding other factors constant, the Vermont Health Care
Reform was a sound idea. However, with political barriers and
mismanagement, the reform did not pick up as expected. The
failure of the Green Mountain Care significantly contributed to
the fall of the program. The complexity and size of the initiative
demanded a functional funding structure and a focused
management system to ensure its full implementation (Joe,
2017).
However, the rise and fall of the Vermont Health Care reform
have been a learning experience for most states as well as the
federal government when it comes to implementing a reform of
such a nature. The idea does not only revolve around the
development of policies and reforms but the impacts it has on
the people as well as the financial capacity needed to run such
reforms. It is, therefore, important to have a flexible and
adaptable system of management that takes into consideration
the unpredictable nature of the impacts of such inventions.
In conclusion, the Vermont Health Care was a brilliant idea
which has been embraced by various countries across the world.
The state government of Vermont ought to have considered the
establishment of a stakeholder network to oversee the

3. management of the reform. Issues dealing with health are
critical to the extent that they can result in the collapse in the
state of credibility on state governments and the incapacity to
implement such reforms.
Reference
William H., (2010). The Vermont Option: Achieving Affordable
Health Care, USA
Joe V. (2017). The Rise and Fall of Vermont’s Single Payer
Plan, Retrieved from http://www.cornellpolicyreview.com/rise-
fall-vermonts-single-payer-plan/ on 10/6/2017
Running head: MASSACHUSETTS’ HEALTHCARE REFORMS
1
MASSACHUSETTS’ HEALTHCARE REFORMS 2
Memo
To: Prof. Thomas Smith
From: Student- Jane Doe
Reference: Health Care Policy
Date: March 18, 2018
Subject: Massachusetts’ Healthcare Reform Act
Massachusetts’ Healthcare Reform Act
Rationale
Massachusetts State is among the states that have made a
number of attempts aimed at reforming the state's healthcare
system to make access to quality healthcare available for its
residents. Recently in 2006, Massachusetts passed the
Healthcare Reform Act, which was later, signed into law by
former Governor Mitt Romney (Van der Wees et al., 2013). The
rationale for this healthcare reform was to provide near-
universal health insurance coverage for Massachusetts’

4. residents.
Adoption of the Reform
The Massachusetts Healthcare Reform Act was passed by the
State legislators after years of negotiation between Mitt
Romney and the legislators with a compromise reached in 2006
resulting in the enactment of the reform that was effectively
signed into law by Romney on 12 April 206. The reform has
made several changes to its healthcare system in a move aimed
at achieving a near-universal healthcare coverage for the
residents of the state. The first change was made to the state's
Medicaid program that was broadened by providing a
MassHealth waiver, extending health insurance coverage to
children in low-income families with up to 300% of the federal
poverty level (FPL) (Kaiser Family Foundation, 2012).
Massachusetts created what is called Commonwealth Care,
which provides the residents of the state with access to
subsidized health insurance for eligible individuals with
earnings below 300% of FPL. Under this new healthcare reform,
individuals with income below 150% of FPL also have the
option of selecting a plan without a monthly premium and low-
cost sharing. However, eligible individuals with earnings falling
between 150-300% PL are subsidized by the state using a
sliding scale.
The Massachusetts Healthcare Reform Act also saw the state
expand its Insurance Partnership Program by providing
incentives and subsidies to the employers to give and workers to
enroll in the state's employer-sponsored insurance. In this
respect, Massachusetts State subsidized insurance costs for the
workers in the state who would otherwise be eligible for
programs subsidized by the government. However, small
businesses are only eligible for up to $1,000 in support per
qualified worker who falls below the 300% FPL (Van der Wees
et al., 2013). Under the program, the state government pays the
portion of qualified workers' premiums that is equal to what the
employees would be expected to pay if employees were on a
subsidized plan. Additionally, under this new healthcare reform,

5. any employer in the state who fails to provide health insurance
to its workers is expected to pay what is called a ‘fair share'
assessment to the government of up to $295 per worker every
year (Kaiser Family Foundation, 2012).
The reform also created what is called the Commonwealth
Health Insurance Connector whose primary aim is to link those
without access to employer-sponsored insurance and companies
with 50 or fewer employees that provide insurance coverage for
its workers. According to this health reform, small businesses
with 50 of fewer employees have the option of buying insurance
coverage on their own or via the Connector (Rapoza, 2012).
Funding Structure
Although Romney and the state legislators agreed on most of
the components of the bill, agreeing on how this healthcare
reform would be financed was a major issue as it was clear that
financing the reform would result in an increase in healthcare
cost. However, following a compromise that was reached, the
state legislators agreed that the reform would be financed by
individuals, employers and the government. First, the
Massachusetts Healthcare Reform is funded by the existing
$320 million obtained in hospital assessments and covered
levies (Van der Wees et al., 2013). Second, the Massachusetts
state legislators agreed that the health reform would also be
financed through by federal safety-net payments of $610 million
as well as federal matching payments on the MassHealth
expansion. Additionally, part of the money to be used in
financing the health care reform is to come from rate increases
projected at $299 million. Further, $295 fair assessment for
employers per employee and the Free Rider Surcharge also
generates revenue used to finance the ambitious health care
reform in Massachusetts (Kaiser Family Foundation, 2012).
Impacts
The impacts of this Massachusetts Healthcare Reform Act have
been so profound. The first major achievement of this
healthcare reform is that it has increased access to affordable

6. coverage to residents of Massachusetts. Because the law
requires all residents of Massachusetts to have a health
insurance or pay a fine, the law had seen more that 99% of the
residents of the state now get health insurance coverage up from
90% before this healthcare reform was introduced. According to
Rapoza (2012), prior to 2006, more than 24% of low-income
residents of Massachusetts had no health insurance. However,
by 2012, only 8% of low-income adults in the state were still
without healthcare coverage. Overall, about 650,000
Massachusetts residents who lacked health insurance are now
covered.
Another significant achievement of the Massachusetts health
insurance is that it has increased insurance status of higher
income persons for the self-employed who did not qualify for
MassHealth. According to Urban Institute, the population of
higher income earners who were without health insurance before
2006 has dropped from 5% then to below 1% three years after
the reform (Kaiser Family Foundation, 2012).
The only notable shortcoming of this healthcare reform is the
cost burden associated with its implementation. The health cost
in the state has risen to a historic high following the
introduction of this healthcare reform was introduced. By 2007,
just one year after the reform, Massachusetts healthcare
expenditure accounted for about 15.2% of its GDP, which is
higher than the nation's average of 13.7% as a whole (Kaiser
Family Foundation, 2012).
References
Kaiser Family Foundation. (2012). Massachusetts health care
reform: Six years later. Retrieved from
https://kaiserfamilyfoundation.files.wordpress.com/2013/01/831
1.pdf
Rapoza, K. (2012, Jan. 20). If ObamaCareis so bad, how does
RomneyCare survive? Forbes p. 1
https://www.forbes.com/sites/kenrapoza/2012/01/20/romney-
care-massachusetts-healthcare-reform/#3d6701195b00

7. Van der Wees, P. J., Zaslavsky, A. M., &Ayanian, J. Z. (2013).
Improvements in health status after Massachusetts health care
reform. The Milbank Quarterly, 91(4), 663–689.
The purpose of this assignment is to familiarize students with
health reform strategies adopted by states. Students will select a
state health policy reform innovation and describe the rationale,
how it was adopted (e.g., federal waivers, passage by state
legislature), the funding structure, and (to the extent statistical
data are available) its impact. Students should summarize their
findings in a 1-2 page, single-spaced memo due Sunday,
October 8th . Examples of state innovations include Maryland’s
hospital rate setting, Vermont’s single payer system,
Massachusetts’ health reforms, Florida’s Medicaid program, and
Kentucky’s Medicaid healthcare program.
Assignment Rubric
Rational Adoption 30 points
Funding Structure 30
Points Impact on Healthcare 30 points
APA Format 10 points