It was May 2011 when then-Vermont Gov. Peter Shumlin signed a “universal and unified health system” act into law and the state began developing plans for broad public health coverage.
Vermont tried—and ultimately failed—to accomplish what had previously been impossible: establish a single-payer health system in the US.
Single-payer systems are a type of universal healthcare that work by having one entity—in this case, the Vermont government—pay for residents’ healthcare through taxes and other public funding. These plans can eliminate the need for private health plans, with countries like Canada, England, Germany, Singapore, Sweden, and Taiwan already offering this kind of insurance.
The hope is if one big group is negotiating costs, then spending would generally come down, as that negotiator would have more power and it would require less administrative work for providers.
Now, Oregon is looking to become the first successful state to implement universal healthcare.
Oregon’s status. To understand what’s going on in the Beaver State, we must first go back to 2019 when it established a task force for universal healthcare.
In 2022, that task force released a report with early insights into how universal healthcare could work in the state, projecting it would cost an estimated $980 million less in 2026 than the existing healthcare system.
The next year, at the recommendation of the task force, the state legislature created a follow-up Universal Health Plan Governance Board (UHPGB) to make a “comprehensive plan to finance and administer” universal healthcare in the state.
The board has until September 2026 to present that plan.
Most Oregonians (97%) are already on a health plan of some kind, according to the Oregon Health Authority, but UHPGB Executive Director Miriam McDonell said many people are underinsured, meaning they have some coverage but don’t use their health plan because care is still too expensive.
This aligns with national trends, too: Nonprofit the Commonwealth Fund reported about 1 in 4 US adults have health insurance but are considered underinsured.
So while most people in Oregon have some kind of coverage, McDonell said it doesn’t accurately demonstrate “the affordability of healthcare” or “the stress that it’s putting on families.”
The goal is to establish “unified financing,” McDonell said, meaning pulling together state, county, and federal funding to remove the need for private health plans (with some exceptions, like for beneficiaries receiving insurance through the Department of Veterans Affairs).
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McDonell said the hope is for the publicly funded plan to be “desirable and less expensive” so Oregon-based employers wouldn’t need to have their own offerings anymore.
Taking its time. Right now, UHPGB is looking to understand how much the plan would cost, working with consulting group Milliman to conduct a review of healthcare spending data from 2023, McDonell said. This differs from Vermont, where the payment plan was to be determined after the law passed.
Nearby, California and Washington are also looking to establish universal health plans, and the states are collaborating to make sure they build out the best options, though an established system is not yet in place in either state.
Taking many years to build out the plan is intentional, McDonell said, as there are a lot of different moving pieces and UHPGB wants to make sure to get it right.
“We’re in it for the long term,” McDonnell said.
Looking eastward. Some say Vermont’s plan was doomed from the start, as the law never spelled out exactly how the single-payer plan would be paid for. By 2014, the program was nixed before anyone got coverage.
These days, Vermont is still facing high insurance costs, ranking first in the nation for how much residents spend, according to a study from personal finance company WalletHub. Nearly 20% of a household’s median monthly income (roughly $1,275 on average for silver-level plan premiums) is spent on health insurance.
But current Vermont state Rep. Brian Cina told us he isn’t giving up on universal healthcare.
For now, he said the state is focused on trying to cut costs as much as possible, including through the independent Green Mountain Board, which was established back in 2011 alongside the single-payer care act to keep healthcare spending down.
Cina said now that there’s an effort to “control costs” for healthcare, he hopes it will put the state in a position to afford single-payer insurance and “provide more of a universal program” in the future.