U.S. Health Care Reform Could Leave Implementation to States
If Congress succeeds in passing national health care reform legislation, much of the responsibility for implementing the changes could fall to states, the Washington Post reports.
Many of the reform proposals currently under debate would require state officials to make decisions about health benefits for low-income families, insurance company regulations and other matters.
Although the House's merged health care reform bill (HR 3962) delegates substantial authority to the federal government, the bill still calls on states to help design a Medicaid expansion and develop high-risk insurance pools.
Under the Senate Finance Committee bill (S 1796), states would need to make nearly every major decision about health reform implementation. The bill would allow each state to establish a health insurance exchange and determine which insurers can participate in the market.
In addition, the merged Senate bill likely would allow states to opt out of any federal public health insurance option.
Experts say a final health care reform bill is likely to more closely resemble the Senate's emphasis on state-based decision-making. Although the federal government will shoulder a large portion of national health reform costs, states likely will need to contribute a certain share and hire more administrators to carry out their new responsibilities.
Experts say that granting states greater decision-making authority could encourage them to adopt health system changes that meet the particular conditions of their region. This model also could allow officials to learn from each state's implementation experiences.
However, others caution that allowing each state to implement health reform could cause some states to fall behind in meeting minimum health system standards (Montgomery/Slevin, Washington Post, 11/1).
Penalties for Massachusetts?
In related news, Massachusetts officials are expressing concern that national health care reform legislation could damage the state's new health care program.
In 2006, Massachusetts passed a health care overhaul bill that aimed to provide health insurance to all state residents through state subsidies and other measures.
However, some current national health care reform proposals would offer federal subsidies that are significantly lower than Massachusetts' current subsidy levels.
Experts say that if Congress does not grant Massachusetts any exemptions, the state might need to decide whether to scale back its subsidies or increase its health care budget in order to close the subsidy gap (Wangsness, Boston Globe, 11/1).
Is California a Model for Cost Control?
California's health care experiences provide "'proof of concept' that properly implemented health reform can control costs while improving the quality of medical care," Micah Weinberg, a senior research fellow in the California Program of the New America Foundation, argues in a Sacramento Bee opinion piece.
Weinberg writes that U.S. policymakers can learn from California's achievements by:
- Addressing health care disparities and other environmental barriers to health care;
- Fostering integrated health care systems such as Kaiser Permanente; and
- Using health information technology to boost care coordination and reduce administrative inefficiencies (Weinberg, Sacramento Bee, 11/1).