The Vermont Legislature passed Act 128 and commissioned this report because they recognized that they must find systematic solutions to the intertwined problems of cost and access that were within Vermont’s broken health system. Act 128 set forth the clear and ambitious goals to achieve universal health insurance coverage, provide every Vermont resident with an adequate standard benefits package and equal access to health care, control rapidly escalating costs, and establish a primary care-based integrated health care delivery system that focuses on prevention and wellness. The research team designed three options for health system reform in order to determine which best achieved the agreed upon goals. REMI developed several models for this report to determine the effects of the proposed reforms on Vermont’s economy, focusing on charges in public health care spending, changes in employer and employee health care spending, and changes in household health care spending.