Vermont's march to a single-payer health care system picked up speed on the campaign trail two years ago.
Then-candidate Peter Shumlin said he'd make Vermont the first state with a single-payer system, with every Vermonter covered by government-sponsored insurance.
Once elected, the governor took action on his campaign promise.
In 2011, lawmakers paid a consultant $300,000 to examine health care in Vermont and design three possible models for universal coverage.
"I know what I present will not be popular with everyone," Harvard economist William Hsiao said in January 2011.
It wasn't. There were missing details. Some questioned the cost. But Democrats strongly controlled the Legislature and governor's seat, so they moved forward fast. A month later, the governor's team came out with its proposal.
The first step-- set up a regulatory board to oversee everything. Next, the state would offer state-supervised coverage to the uninsured through a health care exchange. Then the state would transition all Vermonters to that same health plan.
"I think the risk is that when 2014 rolls around there might be one carrier left in the state and one insurance plan. And whether you can afford it or not, that's what you've got," health care policy analyst Jeanne Keller said in April 2011.
Reporter Kristin Carlson: This will be affordable for folks? More expensive? Less expensive?
Anya Rader Wallack/Special assistant to the governor on health care: No. There's no way it will be more expensive than it would have been without the exchange.
But there was a snag. Vermont needs a federal waiver to enact its own health care plan. President Barack Obama's landmark law-- the Federal Affordable Health Care Act-- only allowed state officials to submit its own plans in 2017. But after lobbying from Vermont's Congressional Delegation and the governor, the White House agreed to offer a federal waiver allowing states to offer their own plans three years earlier in 2014.
Kristin Carlson: You are in this fight for the long haul.
Peg Franzen/Health Care is a Human Right: Yes, we are. It's going to happen.
With all the pieces in place, supporters pushed lawmakers to pass a bill. The group Health Care is a Human Right set up shop at the Statehouse. But opponents also organized with a new group, Vermonters for Health Care Freedom.
"This is one of those issues you can't sit back on because it is going to have an impact on every Vermonter for a lot of years," Darcie Johnston of Vermonters for Health Care Freedom said in March 2011.
Opponents lost that first battle and lawmakers passed a health care bill as supporters cheered in May 2011.
"This is the first time that a state will take a major step in establishing health care policy and health care as a public good," said Sen. John Campbell, D-Vt. President Pro Tem.
"It's the first step therefore of taking away Vermonters' health care choices as they now know it. The uncertainties for business remain," said Rep. Heidi Scheuermann, R-Stowe.
The Green Mountain Care board was named that fall. The five people are in charge of setting up Vermont's new health care system; deciding how much doctors get paid, how much hospitals can spend and what services Vermonters will have when the state moves to a single-payer system.
This year, lawmakers continued on the single-payer path, designing the health care exchange just last month. By seeking a federal waiver Vermont hopes to make its own rules, setting up a marketplace for health insurance and mandating it. The federal law does not.
Vermont businesses with fewer than 50 employees will be required to drop their insurance plans by 2014 and buy into the exchange. By 2016, businesses with fewer than 100 employees will be added to the exchange. And by 2017, all Vermont will be all in, completing the journey to single-payer but not ending debate.
"We wanted to make sure it is easy for people like you and me to be able to get insurance. We didn't want to make it any harder, we actually wanted to make it easier at a better price and I think we did that," Sen. Claire Ayer, D-Addison County, said last month.
"The scariest thing perhaps is that the Legislature, by making the exchange mandatory, is once again thumbing their nose at federal law and it's just reckless to behave in this way," Jeff Wennberg of Vermonters for Health Care Freedom said last month.
The next step in Vermont is to set up that health care exchange. That will be the focus of next year's legislative session, including how to pay for it. As far as the single-payer system, Vermont still needs a federal waiver to set it up before 2017. If that waiver comes through, next year could also be the year we learn how much single-payer will cost and how much people will pay.