As Vermont continues along the path of reforming health care and health insurance we must keep our eyes on the prize: quality health care that is affordable while controlling costs.

There are many unanswered questions about the proposed state run "single payer" health insurance program called Green Mountain Care (GMC). We do not yet know what the benefit coverage will be, what the cost will be, and how the high cost of the program will be paid for with state tax revenue. Pursuing this path may be risky, difficult, complex, expensive, and disruptive to the current system. Serious evaluation of alternative ways to achieve the goals that we all share is long overdue.

Vermont now has the health insurance exchange Vermont Health Connect (VHC) that is required by the Federal Affordable Care Act (ACA). The Administration and the Legislative majority made profound errors in policy and execution in the design and implementation of this program. Despite those mistakes, the Federal tax subsidies available to low and middle income Vermonters when purchasing insurance through VHC have made better insurance coverage cost less for many. Others have been eligible to enroll in expanded Medicaid coverage. These are improvements in affordability.

The projection is that the number of uninsured Vermonters may be down to about 13,700 or 3 percent by the end of 2014. This is a reduction from around 42,000 or 7 percent several years ago. We must continue outreach to enroll uninsured Vermonters. But this is getting close to universal coverage.

The options for insurance coverage have improved as well. The ACA requires coverage of pre-existing conditions, so that Vermonters need no longer fear that an illness will mean that they cannot get affordable health insurance. The separation of health insurance from employment is now possible. Individuals can purchase coverage through VHC if they do not get insurance through their jobs or if they are self-employed. Businesses have the option to stop offering health insurance so that their workers could purchase through VHC if that makes sense for them.

Even before the implementation of the ACA, Vermont had embarked on programs intended to increase the quality of health outcomes while controlling costs. The Blueprint for Health is designed to improve the provision of health care for Vermonters with serious and chronic illnesses through better coordination. The results of the pilot projects are encouraging in terms of both health outcomes and cost.

Other experiments with payment reform are being undertaken.

All successful approaches to improving quality and controlling cost should be expanded and intensified.

In addition to continuing policies with proven success, we must guarantee that Vermonters can make choices about insurance and about health care providers. Participation in the exchange should be voluntary rather than mandatory. Vermonters who want high deductible health savings account plans with lower premiums should be able to find a greater variety of them both inside and outside VHC.

Preventing illness is one of the best ways to lessen suffering and to control costs. It is essential to include insurance plans that offer financial incentives for Vermonters to take care of their health. Perhaps fifty percent of the factors that determine whether or not we are healthy are related to our own behavior.

Finally, in order to ensure that Vermonters can get access to the care that they choose, we must support the quality and quantity of doctors and hospitals. Re-imbursement rates must be sufficient to allow health care providers to cover costs. Programs that assist in repaying medical school debt for doctors who have stayed in Vermont could be expanded.

We have made considerable progress towards health care access, quality, and affordability. Policies that build on the current system can help us to make further progress by strengthening flexibility, capacity, and sustainability. These careful initiatives can be financed within the existing funding streams.

Vermonters need such reliable investments in health reform to reach our goals. I am not sure we can afford the risk and uncertainty, the massive tax increases, and the system disruption of the state run "single payer" GMC.

Cynthia Browning represents the towns of Manchester, Arington, Sunderland and Sandgate in the State Legislature.