MONTPELIER, Vt. (AP) -- When it comes to federal money to help states set up health care exchanges under the Affordable Care Act, you might expect that California would rank first and New York second.
But here's a surprise: Tiny Vermont comes in at No. 3.
An Associated Press analysis of data from the U.S. Department of Health and Human Services shows Vermont has been granted more than $158 million so far in these early stages of compliance with the federal law to help set up the new regulated health care marketplace. The new systems are scheduled to be up and running in October.
California so far has gotten about $236 million, New York about $183 million. Vermont's population of about 630,000 would make it California's fifth largest city.
"We've been very aggressive in trying to bring down federal dollars that will ensure that the assistance that Vermonters will need in making the transition to purchasing health coverage through the exchange is there," Mark Larson, commissioner of the Department of Vermont Health Access, said Friday.
Vermont also got an earlier start than many other states, some of which had held back to see if the 2010 federal health care overhaul might be struck down by the U.S. Supreme Court or turned back by a Republican victory in the 2012 presidential election, Larson said.
"Certainly, there have been a number of other states that have been waiting for the outcome of the Supreme Court ruling and waiting for the outcome of the election," he said, and have not pursued every funding opportunity that Vermont and a handful of other blue states have.
Since plans for the federal health overhaul still stand, other states are expected to step up with funding requests, and totals sent from Washington are sure to change.
Democratic Gov. Peter Shumlin and the Democratic-controlled state Legislature have been fully on board with the idea of increasing the government's role in health care. After the federal government in 2010 rejected the so-called "public option" — government-run insurance available to all — Vermont embraced it.
In 2011, the state passed a law putting it on a path toward using the exchange, called for under the federal law, as a springboard to what's expected to be the closest thing in the country to a Canadian-style, government-run health insurance system by 2017.
But the first order of business has been setting up the exchange, to be called the Vermont Health Connect. Robin Lunge, director of health care reform for the Shumlin administration, said one of the challenges has been explaining to the public what the exchange is and how it will work.
Many consumers will find it similar to an online travel site like Orbitz or Expedia, except instead of comparing the prices of airline flights, what the baggage fees are and what times the flights leave, they will be comparison shopping for health insurance plans. For those less web-savvy, plans call for the exchange to pay for "navigators," people who can guide consumers through the process of using the system.
Lunge attributed Vermont's funding success to early and thorough applications for federal grant money, adding that early states are likely to be seen as examples for those that follow.
"We documented our needs and our requests. It's not like they added bonus money or anything like that," she said.