But waivers won't be available until 2017. In today's political climate, five years is an eternity. Whether that necessary bit of dispensation ever comes depends "on the administration in Washington," Richter adds.

If it could happen today, there would be "a good chance" of success, she adds. "Obama has said if he could do it over, then single payer would be the way he would go. He's also said he believes in states' rights to innovate and do some models on their own." If it's the Romney administration? "I don't think so."

The next few years will be pivotal – on policy, politics and public opinion fronts.

"There's a lot of misinformation out there," Franzen says. "There's been a real attempt to spread a lot of fear. Which we knew would happen. When we got into this, we all knew it was going to be a five year or more battle."

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In the meantime, work toward a better healthcare system has been moving forward in earnest. In the year since Act 48 was passed, the Green Mountain Care board has been hard at work on projects around cost containment, says its chair, Anya Rader Wallack.

"Right now we're very focused on trying to implement payment reform models in the state, moving away from fee-for-service," she says. "And we're working with providers around the state to develop some models for doing that."

Other responsibilities include "a whole realm of benefit design, for both our health benefit exchange and the single-payer financing plan that the governor's office will be bringing back to the legislature next year," Wallack says. "For both of those purposes we have to sign off on a benefit package that would form the floor, essentially, for everyone in Vermont. We are waiting for recommendations on those and will have to delve into whether to approve them."

In terms of the single-payer law, "there's still a lot of work to be done," she says. But, "as for our work, we're sort of off and running. We have those responsibilities, regardless of what happens in the future with the single-payer plan."

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Nationally, whether the ACA stands or falls "doesn't really affect our work at all," she adds, referring to the Green Mountain Care board. "It affects the single-payer plan, and it affects our implementation of the health benefit exchange, because if the [individual] mandate is removed, it means the state will have to determine whether to pass a mandate at the state level to assure everybody's covered."

Single-payer may have far to go before it's a reality. But even if it ends up a vanishing pipe dream, Vermont is in much better shape, when it comes to keeping its citizens covered, than most other states.

By the same token, even if the Affordable Care Act is upheld and goes into full effect, "at best, it will bring the rest of the country to where Vermont already is," Richter says. "Act 48 was intended to go beyond that."
"Regardless of what happens with [single-payer], or with ObamaCare," Wallack adds, "if we do our job right, we'll have a more sustainable, higher-quality healthcare system, I think, than anywhere else in the country."

For more of our politics coverage, visit Political Malpractice: Healthcare in the 2012 Election.