HELENA - Gov. Brian Schweitzer made headlines last week when he told reporters he's asking the feds to allow him to set up a "universal health care" program for Montana, using federal funds to underwrite a big health insurance pool that citizens could buy into.
Sound good? Maybe. But even the governor himself acknowledges his proposal is the longest of long shots, and could require state legislation - which can't even be considered until the 2013 Legislature, when he's no longer governor.
Schweitzer said Friday he's making the proposal because Montana will have to do something about the federal Medicaid program, which he said will "bankrupt the state" if it's not revised when it nearly doubles under planned federal reforms in 2017. Medicaid is the state-federal program that pays medical bills for the poor and disabled.
Yet in one state - Vermont - people are doing more than making suggestions. They've taken concrete steps to create a statewide health plan that will cover all its citizens and, they hope, cut down on duplicative services and contain the rising health-care costs that governors and other leaders know are out of control.
"The cost of health care is literally eating our budgets alive," says Vermont state Rep. Mike Fisher, who chairs the Vermont House Committee on Health Care. "At the current rate of inflation, we're not going to have any money to do anything besides health care if we don't address these needs."
How is Vermont doing it? Gov. Peter Shumlin, a Democrat elected in 2010, ran on the issue, and the Vermont Legislature passed legislation this year to set the process in motion.
Among other things, the legislation created the Green Mountain Care Board, a group of health care experts and business people being paid to work full-time on designing and developing Vermont's plan.
Vermont first plans to set up a health insurance exchange, as required by the federal health reform law, to offer private insurance plans starting in 2014. It then hopes to use the exchange to transition to a statewide plan that will cover any and all Vermont citizens - except those who choose to stay on private insurance or are covered by Medicare, the federal insurance plan for the elderly.
The state plan, dubbed Green Mountain Care, is scheduled to launch in 2017, if Vermont can get the needed approvals from the federal government. State officials hope it could be earlier.
Vermont is calling it a "single-payer plan," which usually means a taxpayer-funded plan where the government is the insurer for all. Details on its financing and what it will cover have yet to be worked out, however.
Robin Lunge, Vermont's state director of health care reform, says the single-payer approach has gained support because Vermonters believe it can squeeze out administrative waste by getting rid of duplicative billing and other financial functions, yet still cover everyone.
"We've had different studies on how to reform the health care system, and every study we've done has said single-payer is the most cost-effective way to do it," she says. "If (people) think it's going to save them money and cover everybody, people think it's the way to go."
Health care reform in Vermont hasn't all been a political walk in the park, however. Democrats firmly control the Legislature and support it, but the business and health care community is split on the issue and there's "a great deal of nervousness" about how everyone will be affected, Fisher says.
Back in Montana, it's been mostly a political non-starter or stalemate when it comes to big ideas on health care. This year, Republicans who controlled the Legislature proposed a number of "market-based" reforms designed to encourage people and small businesses to buy high-deductible, low-cost insurance plans, or make such plans more available.
Those plans either died in the process or were vetoed by Schweitzer, a Democrat. Republicans also killed any proposal related to federal health reform.
Schweitzer also hasn't presented any sweeping health care plans himself to the Legislature while he's been governor. Now, with 15 months left on his final term and barred from running for re-election because of term limits, the governor is floating a big idea, to use federal dollars and local community health centers to create a plan that will offer basic, affordable care for many.
He said Friday he hasn't talked with hospitals, physicians or community health centers specifically about his proposal. If it needs legislation, he said he might propose it for the 2013 Legislature. Yet he won't be governor then.
"We're just seeing how all of this unfolds, and how many Medicaid patients are pushed our way," he said.
Meanwhile, in Vermont, reform marches forward.