Health Reform Creates Challenges for States
By Mary Branham, CSG Managing Editor
and Mikel Chavers, CSG Associate Editor
The epicenter of the health care debate is in Washington, D.C., these days, but the ripple effects of any Congressional action are sure to affect states.
And state officials have several priorities for any kind of reform, said Alan Weil, executive director of the National Academy for State Health Policy, an independent academy of state health policymakers.
He said leaders want to connect people with the services they need, bring better coordination and integration in the health care system, improve care for people with complex conditions, orient the health care system toward results and promote a more efficient health care system.
“States are struggling under the burdens of programs they already run,” he said. “The notion that they are now going to turn all their energy into this expansion … is, I think, unrealistic.”
Weil was among several speakers at various health care policy sessions during The Council of State Governments Annual Meeting Nov. 12-14.
Weil said states have five needs in implementing reform. They’ll need to know what is in the legislation, if and when it passes. They need to support strategic and implementation planning, he said. In addition, states will need topic-specific technical assistance and will need to focus on communication, both internally and with the federal government, as well as coordination within agencies.
“States will benefit if all these efforts are coordinated with what they’re doing now in terms of their own health agendas and some of the existing efforts,” he said.
As is often the case, states are leaders in health care reform. In fact, when Weil talks about
health reform in the states he always mentions the trilogy—Maine, Massachusetts and Vermont. He’s seen health reform initiatives that span the spectrum.
And a lot of what’s being discussed in Washington already is happening in the states, Weil said.
“It’s clear that the structure of the federal bill draws on state’s experience,” Weil said.
But the approaches are all different, even those in the trilogy, he said.
The Massachusetts health care reform plan, he said, tackled issues of coverage first and will tackle cost later. Maine, on the other hand, is working on costs and coverage simultaneously, he said. In Vermont, the state started with chronic care management—there is a community-based organization designed to help people manage their chronic conditions, Weil said.
One example of an innovative approach is Washington Basic Health. The state-subsidized program provides low-cost health insurance coverage through private health plans. The 22-year-old program purchases health insurance for more than 500,000 low-income residents, according to Preston Cody, assistant administrator to the plan.
Washington Basic Health offers an important example, particularly because the national health reform plan includes an option for states to opt-in to a state-subsidized health care option, Cody said.
Washington is proof of how that works.
In the 22 years of operation, the program has put people on waiting lists three times, including now, said Cody.
“But that’s where we are today with the economic situation,” he said. “The recession has created numerous challenges on our state budget.”
And with zero federal matching dollars, that meant the program had to take a more than 40 percent budget reduction this year, according to Cody. That translates to covering fewer low-income folks who need health insurance coverage.
Participants in the state-subsidized plan share the responsibility for paying for the low-cost coverage and pay on average $60 a month in premiums, Cody said.
“Without this program in the state a lot of people would simply choose to go without health insurance,” he said.
But the changes being proposed in Congress will create challenges for states, particularly with the cost, said Jane Cline, West Virginia’s insurance commissioner.
“States do not have an extra $600 billion lying around,” she said.
For insurance commissioners, the most important aspects of the bill would be the sweeping reforms to improve access and equity.
“Insurance market reforms promise to make health insurance fairer, more transparent and more available,” she said, but those reforms would come with a price.