Keep it simple

It's hard to imagine two states more diverse than Kentucky or Vermont.

One is about the "reddest" or most conservative state in the nation, politically speaking anyway. During that previous presidential election, Mitt Romney carried the state by a margin of 60 percent to 38 percent for President Obama. Both its U. S. Senators are Republicans.

The other one is Vermont, one of the politically liberal states and about as "blue" as they come.

Kentucky is known for coal mining, horse breeding and is one of the top ten states when it comes to rates of poverty as well as dismal statistics for state health standards (unlike Vermont, which has some of the best). But it's figured out a way to make its health exchange, known as "Kynect" work, unlike Vermont, which in theory should have had an easier time given we're a smaller state with relatively fewer people to start with who were without health insurance coverage, unlike Kentucky.

And as we were reminded again last week, Vermont Health Connect, our state's health exchange, set up under the federal Affordable Care Act, is still sputtering. Things have improved a lot since the early days when signing up for health insurance was problematic for many, if they could do so at all. But they are still bad enough, nearly a year after the initial rollout date of Oct. 1, 2013, that the state finally pulled the plug on its contract with CGI, a Canadian computer and technology firm hired to develop the state's health exchange. Seventy-one million dollars later, the governor and his health insurance team finally caved in to reality - partnering with CGI proved an expensive mistake.

You can't blame CGI completely, given the complexity of the task and the fact that the Canadian company was also a leading contractor for the federal government's health exchanges. And Vermont was foolish to insist on people buying their health insurance solely through the online exchange, rather than through any source. That added to the strain. But, come on. Some kind of accountability is in order.

Kentucky, which also set up its own exchange, rather than relying on the feds to do that, has shown that health exchanges can work, with more than a half-million of their residents successfully signed up without any of the issues that seem to have plagued Vermont's foray into the brave new world of Obamacare. What's more remarkable is that the political environment of Kentucky, which in theory should not have been hospitable ground, turned out quite receptive to the idea of mandatory health insurance, once it was explained and when the online exchange was an asset, not a hindrance.

What's at issue here is not "Obamacare," which was an overdue overhaul of the confusing patchwork way in which we as a nation finances medical care and coverage. But clearly, Vermont could implement a few tweaks to the system and allow more latitude for people who don't qualify for federal subsidies to buy their insurance elsewhere other than Vermont Health Connect.

"Keep it simple" is often good advice, but the governor and his team presumably saw Vermont Health Connect as the first step towards a grander Single Payer Plan, the details of which we still know little.

Apparently many lawmakers don't know much more. One of our local state representatives, Cynthia Browning, has filed a much discussed lawsuit against the state following a denial of a public records request for information on how single payer was to be financed. The governor is claiming executive privilege, which is allowable under the state's public records law, but here is a case when a little transparency might go a long way.

The governor has said he will share his ideas on financing single payer next January when the Legislature convenes. But that's what was supposed to happen the year before, and didn't.

Given our recent experience with Vermont Health Connect, a little more transparency seems in order. Too bad there's the awkward political calendar in play and a re-election to be fought. But given Mr. Shumlin's massive lead in the polls and in campaign funding, sharing at least a smidgen of his thinking on this subject doesn't seem like much to ask. Single Payer is a bold gamble, and a good time to start learning more about it, when people might be paying attention, is a political campaign.


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