Vermont once dreamed of universal healthcare. This Democrat wants to try again — with a twist.

Protest signs seen at protect Medicaid lights up Capitol amid budget showdown, on May 7, 2025, in Washington, DC. | Leigh Vogel/Getty Images for Caring Across Generations Twelve years ago, Vermont Democrats tried to make their state the first in the nation to have a single-payer government-financed healthcare system — a bold experiment to push the limits of American health coverage when Obamacare was just being launched.

Their plan failed , and rebooting it became politically impossible, even in Vermont: The Democrats lost the governorship to Republican Phil Scott for what turned out to be a decade.

This year, that could finally change.

A progressive political newcomer named Amanda Janoo is taking on Scott in what polls show is a tight governor’s race .

And if she wins, the state could be poised to try a whole new national experiment: one of Janoo’s central campaign promises is to create a pioneering health system where the state pays the full tab for primary and preventive care, while leaving the rest to the existing system.

Key takeaways Amanda Janoo, the Democratic nominee for governor of Vermont, wants to move primary and preventive healthcare to a single-payer system — where the state would pay providers for such care, make it free for patients, and cut insurers out.

Previous attempts to pass or enact full single-payer systems have failed at the state level, including in Vermont in 2014.

Janoo is trying to focus first on this one relatively smaller slice of the health system, but hopes it could be a starting point to full single-payer reform eventually.

Yet even this more limited reform faces difficult political and practical challenges.

Janoo’s candidacy is an example of the policy experiments that are becoming possible nationwide in a projected “blue wave” year, when Democrats could sweep into power in a number of states.

But in the healthcare universe, her plan is also an example of how even progressive policy idealists are trying to learn from past failures and focus on what they think can actually be achieved.

Compared to the sweeping ambition of Vermont’s 2014 effort, or Bernie Sanders’s signature “Medicare-for-All” idea, Janoo’s proposal for single-payer has very specific limits.

Under Janoo’s proposal for “universal primary and preventive care” (she typically avoids the term “single-payer”), the state government would pay for Vermonters seeing primary care providers such as doctors and nurse practitioners.

This government coverage would be universal and free for patients, and insurance companies would be cut out.