Reform Costs, Public Option Emerge as Key State Issues
The proposed expansion of Medicaid under both the Senate and House health reform bills has state lawmakers worried about being saddled with the high costs of expansion, the New York Times reportsÂ (Sack, New York Times, 11/11).
For example, California's budget crisis already is hindering Medi-Cal, California's Medicaid program, in its current state. Adding 1.6 million new enrollees to the program would be extremely difficult if not impossible, according to Reuters.
"Our No. 1 concern is just the fiscal reality that we can't afford our current program," Toby Douglas, California's chief deputy director of health care programs, said during a conference of state Medicaid directors on Tuesday. He added, "We can't afford expansion."
Alabama estimates thatÂ the proposalÂ would add 200,000 to 300,000 new enrollees to its Medicaid program, a tricky proposition when the state is "not real sure how we're going to get through tomorrow," said Carol Steckel, the commissioner of Alabama's Medicaid agency.
States also could face challenges creating the insurance exchanges that reform legislation would mandate. Nevada anticipates spending $150 million to build information technology for an exchange and would need to employ 100 new staff members to run the exchange, according to Chuck Duarte, administrator of Nevada's health care financing and policy division.
Linking the exchanges to Medicaid systems to ensure that residents are directed to the most affordable insurance option also would be difficult, but states will have "no transition time" once reform is passed, according to Steckel (Lambert, Reuters, 11/10).
Public Option Emerges as 'Litmus Test' in State Elections
Meanwhile, Senate Majority Leader Harry Reid's (D-Nev.) plan to include a public option provision in the Senate's final health reform bill "has emerged as a litmus test" in some gubernatorial campaigns. The plan Reid is considering would allows states to opt out of the public option.
Several conservative states oppose the public option, and gubernatorial candidates in those states have portrayed themselves as likely to opt out, if elected. Although a public plan would not be enactedÂ until four yearsÂ after reform legislation becomes law, there are 37 gubernatorial races next year that would determine how states respond to the public option.
Gubernatorial candidate and Rep. Artur Davis (D-Ala.), who voted against the House's health care bill (HR 3962) on Saturday, has come out against the public option.
In Florida, the Republican front-runner for governor in 2010, state Attorney General Bill McCollum, said that a public option would "put the viability of private health insurance in grave question" but did not declare that he would absolutely opt out of the plan.
His Democratic opponent, state CFO Alex Sink, has avoided taking a position on the issue, saying that "it makes little sense to predict how Florida would respond until we have hard information about the bill's requirements and options."
In Virginia and New Jersey, which held gubernatorial elections last week, the issue surfaced during the final weeks of campaigning. Gov. Jon Corzine (D-N.J.) publicly announced that, if re-elected, he would not opt out of the plan. His Republican opponent -- Christopher Christie, who won the election -- said that he does not support a public option.
In Virginia, the Republican contender Robert McDonnell, who won the election, said that he would opt out of the plan, while his Democratic opponent, Creigh Deeds, said that he would consider it (New York Times, 11/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.