The Vermont Breakthrough: Grassroots Organizing Moves a State towards Health Care for All

This article was originally written for and published in the Summer 2011 issue of Social Policy

On May 26, Vermont’s new governor signed a universal healthcare bill that promises to be truly universal, in contrast to the federal Affordable Care Act. While the passage of the bill itself has received attention from the national media, few have told the story of the grassroots organizing that made this breakthrough possible, changing what is “politically possible” through a massive campaign that has engaged tens of thousands of working-class and low-income Vermonters as political actors.

More than anything else, this bill owes its passage to the Healthcare Is a Human Right campaign, spearheaded by the Vermont Workers’ Center (VWC). Founded in 1998 by a group of young, low-wage workers in Central Vermont, the Workers’ Center’s mission is building a democratic, diverse movement of working and low-income Vermonters to achieve an economically just and democratic Vermont. We seek a Vermont in which all residents have living wages, decent health care, childcare, housing, and transportation. For over a decade, the VWC has worked to build working-class power through livable wage campaigns, union solidarity, innovating organizing, coalition-building, community campaigns, and direct action.

The VWC launched the Healthcare Is a Human Right campaign in 2008 as a natural outgrowth of our mission to build working-class power. Healthcare had emerged as an issue across all our work — as one of the main issues in strikes, as one of the biggest costs driving public-sector employers to want to cut and/or privatize services, and as one of the biggest issues for unorganized workers in sectors like retail which make up a huge proportion of jobs in Vermont. It is an issue with great potential for uniting the working class, as nearly everyone has had experiences with the dysfunctional U.S. healthcare system, or has had family or friends who have. As a statewide political issue, it offers all Vermonters a chance to participate. Finally, and perhaps most importantly, it was a campaign that allowed us to go on the offensive, and demonstrate that grassroots organizing can actually achieve victories which improve the material conditions of the working class as a whole — instead of the pattern which we had been stuck in, of defending past victories.

Inspired by the International Worker Justice Campaign led by UE Local 150 in North Carolina — a campaign to repeal the state’s ban on collective bargaining in the public sector which uses international human rights standards as its framework — we adopted the human rights framework for our healthcare campaign. By keeping human rights at the center of our campaign, we developed a campaign language that connected with working people at the level of values, rather than through the abstract and often confusing language of policy. The human rights framework also encourages movement-building discussions of how healthcare intersects with other issues such as domestic violence, racism, immigration, war, privatization, and attacks on the public sector.

The first phase of the campaign had three main components. We developed a “human rights survey” as a grassroots organizing tool, which allowed us to engage over a thousand Vermonters in a conversation about healthcare which began with their experiences and their values. We also worked to frame the healthcare crisis as a human rights crisis, and to build relationships with other movements and sectors, through human rights hearings held around the state which allowed people to tell their stories, a human rights report released on International Human Rights Day, December 10, and a human rights conference held the following weekend which drew over 500 people. The third component of the first phase was building for a mass rally at the statehouse on May 1st, 2009, which fell on a Friday. Choosing to focus on a direct action, rather than legislation, meant that we had to have conversations with our growing base about the nature of political power, to expand our collective understanding of “politics” beyond elections, online petitions, and polite lobbying of legislators — the “low intensity” democracy that is taught in high school civics classes.

Well over a thousand people showed up at the statehouse — the largest weekday rally in Vermont in recent memory. The HCHR campaign had succeeded in establishing a statewide network of organizing committees, including committees in the traditionally more conservative rural areas of the state.

On the opening day of the 2010 legislative session, dozens of Vermonters in red “Healthcare Is a Human Right” t-shirts delivered thousands of postcards to legislative leaders demanding that they hold hearings on H.100, a bill that outlined a single-payer healthcare system for the state. In addition to collecting postcards, the campaign had been busy in the fall holding “People’s Forums” around the state, to showcase working-class people’s often moving stories of struggling to get the care they need for themselves and their loved ones, and to ask legislators to commit to supporting five Human Rights Principles for healthcare reform.

The Human Rights Principles — Universality, Equity, Transparency, Accountability, and Participation — were developed together with the National Economic and Social Rights Initiative (NESRI), which have been a key national partner in this campaign. As we entered the legislative fray, the principles have been an invaluable tool in helping to evaluate actual legislation, while keeping our “eyes on the prize” of a values-based campaign. Numerous healthcare reform bills were floating around the legislature; despite the fact that we were told that H.100 was outside the realm of the “politically possible,” it was the only bill that began to meet the five human rights principles.

Legislative hearings were flooded, generating grassroots pressure in every legislative district around the state, and after another huge rally on May 1st, H.100 became law as Act 128 in May of 2010, when the Republican governor chose not to veto it. The bill set out a road map for Vermont to develop a healthcare system that treats healthcare as a public good, and explicitly included the five principles of universality, equity, accountability, transparency, and participation. It provided for the state to select an architect to develop three options for how to get there, and Dr. William Hsiao of Harvard, who designed Taiwan’s single-payer system, was chosen.

After Dr. Hsiao delivered his plans in January, the house and senate held joint hearings on what would become H.202, “An Act Relating to a Universal and Unified Health System.” The hearings were done through Vermont’s Interactive Television system, which allows people at over a dozen sites throughout the state to participate via video conferencing. Each site was packed with VWC members and HCHR campaign supporters. Follow-up hearings held by the Senate – even one dedicated solely to hearing testimony from business – showed overwhelming support in the state for moving forward for universal healthcare. When IBM – the largest private employer in the state and frequently referred to as the “big dog” of state politics – expressed reservations about the bill, the VWC and allies from the Alliance@IBM, a “non-majority” union of IBM workers, held a press conference exposing IBM’s claim that they already provide quality healthcare for their employees and denouncing the company’s lobbyists for claiming to speak on behalf of IBM’s workers, who support universal healthcare. H.202 eventually passed both houses by wide margins. The “politically possible” had changed.

The Workers’ Center believes that the successes of the HCHR campaign stem from three key components:

1. Mass Organizing. At every stage of the campaign, we have had a mass organizing component – a survey, postcards, a petition, a call-your-legislators campaign – in which we asked large numbers of people to participate in the campaign in a small but tangible way. In addition to generating pressure on legislators, these mass campaigns keep us constantly talking to the “unorganized,” they provide a simple way for people not only to support the campaign but to feel like they have contributed to it, and they provide opportunities for emerging leaders to develop organizing skills, for instance by asking a few friends or family members to sign a petition or make calls.

2. A Struggle over Values. Using the human rights framework and keeping the actual experiences of working-class people with the healthcare system central to our campaign has kept us connected to our base at the level of values about what they hold most dear: their children, parents, spouses and partners, and their own bodies. Framing the healthcare struggle as part of a broader movement for social justice has kept us connected to allies in other movements, working on other fronts of the struggle.

3. Real Leadership Development. One of the biggest barriers to building movements for fundamental social change is the belief that change comes only through elections, or comes only through “practical” single-issue campaigns, or – most commonly – is not possible at all. Developing leaders who understand and consciously work to undo these ideas, and address the underlying systems of patriarchy, white supremacy and capitalism that produce them – is one of the most pressing tasks for our movement. The HCHR campaign has addressed this need both through popular education workshops and “solidarity schools” for our members, but also through being flexible enough in our strategies and tactics to be open to the creativity and initiative of our members, helping them to see themselves as protagonists of the struggle, not just obedient foot soldiers.

The importance of all of these was made abundantly clear at the very end of the legislative session, when the State Senate – by a large majority – added an amendment to the healthcare bill explicitly excluding undocumented workers from coverage. We had a choice: we could risk derailing the whole bill by raising opposition to the anti-immigrant amendment, or we could abandon the principle of universality in the name of “pragmatism.”

Fortunately, we had built the kind of movement that allowed us to make the first choice, and to win. From years of leadership development work – including explicit anti-racist education – our grassroots leaders in this overwhelmingly white state understood why this amendment had to be opposed. We could point to the Human Rights Principles we had campaigned on, to make the case that this amendment violated principles of universality and equity. We had the ability to turn out masses of people for a May Day rally that truly addressed both healthcare and immigrants’ rights. In the conference committee, the amendment was struck from the final bill.

The bill signed this May is not a single-payer system – though it does commit the state to moving towards one by 2017. Key questions about funding mechanisms and the scope of benefits will be fought out in future legislative sessions, and corporate interests will no doubt pour hundreds of thousands, if not millions, of dollars into the state to defeat real healthcare reform.

The Workers’ Center is under no illusion that this will be an easy struggle, but we believe that we are on the right path, and we look forward to working with allies in other states and fighting on other fronts of struggle, so that more of our movement can go on the offensive towards winning the world we wish to see.