Dr William Hsaio, perhaps the world's foremost expert in the implementation of new health care systems, has delivered a report to the Vermont General Assembly recommending that the state adopt single payer health care based on a hybrid means of financing. Financing would stem from an employer-employee payroll deduction; benefits would be comprehensive and come with a low co-pay. It leaves Vermont Medicare and Medicaid intact, apparently because eliminating them would greatly complicate implementation. The General Assembly is expected to pass some version of Hsiao's proposal. The state would then request a waiver from the Affordable Care Act, which the Obama administration would almost certainly grant.
Implementation of a single payer program would be a health care reform development on the scale of Medicare and the Affordable Care Act. Hsiao estimates (conservatively, he says) that Vermont will save 25% of expected health care costs between 2015 and 2024. If the plan delivers as promised, pressure will grow on other states to reduce costs by expanding coverage and benefits. HealthMatters details the proposal here.