The government of Vermont continues to chug along with their multi-year plan to establish a universal health care system modeled on single payer. The most recent step is that the two chambers of the legislature have approved a new bill creating the health care exchange required by the Affordable Care Act.  From the Bennington Banner:

By a 20-7 vote, the Senate approved a House-passed bill that sets up a regulated health care marketplace, or exchange, and requires employers with 50 or fewer workers either to enroll their employees in the exchange or let them do so on their own, taking advantage of federal tax credits or subsidies to help them pay for it.

“It’s our intention to use the … exchange as sort of a pivot point,” said Sen. Claire Ayer, D-Addison and chairwoman of the Senate Health and Welfare Committee, in an interview after the Senate vote. “We want to take full advantage of it in terms of helping us define some of our cost-saving processes, develop our health information technology and get ourselves on a path to a single-pipe payer.”

The eventual plan in Vermont is to create a universal public health insurance system, but the Affordable Care Act doesn’t allow states to apply for a total wavier to create a better system until 2017. This means Vermont is required to create an exchange for 2014, which the state will try to use as a stepping stone for implementing their full plan in 2017, if they receive the necessary waivers.

As part of this long term plan, the bill will require individuals and small businesses to purchase insurance only through the newly created exchange. The hope is to get a high level of participation in the exchange and maximize the amount the federal government will provide the state.

The ACA’s continuing unpopularity means federal Democrats mostly avoided the issue of health care and have effectively given up on promising to improve the law. That means for the foreseeable future the best hope for getting progressive reforms will probably come from the states.