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New Online ‘Refor(u)m’ for State Health Issues

State efforts to enact national health care reform have proceeded at different paces — a situation made clear in a new online forum designed to help states implement the Affordable Care Act.

At a recent forum featuring representatives from North Carolina, New York and Virginia, the wide disparity of progress among the states became apparent.

It was part of an effort to get states to talk to each other about implementation of national health care reform, coordinated by a recently launched website.

The State Refor(u)m site,managed by the National Academy for State Health Policy and funded by the Robert Wood Johnson Foundation, is designed as hub of information for state health policy officials working on implementing health care reform.

In the recent forum featuring North Carolina, New York and Virginia, officials from each state painted vastly different pictures. The three states are at various stages of reform. Of the three, only Virginia has enacted legislation stating an intent to create an exchange, and it has not yet defined the makeup of the exchange board, among other details.

New York, with a Democratic governor and Republican-majority legislature, couldn’t move on many health care issues until it could cut $2 billion from the state’s Medicaid program, according to Greg Allen, director of the New York State Department of Health.

“We were thinking we couldn’t bring Medicaid into the Affordable Care Act as it was,” Allen said. “So we redesigned Medicaid. We spanned the state, got a lot of ideas regionally, then brought them back to the state level. We chewed through lots of ideas and came up with a reform agenda.”

That effort set the stage for health reform in the state, Allen said. “This was a very successful framework,” he said. “Stakeholder engagement is very important.”

Virginia has a governor who opposes health care reform, and yet recently has moved quickly to implement it, according to Joe Flores, a legislative analyst on the Virginia Senate Finance Committee.

“The governor was not in support of the law, but is moving the state forward. He and the legislature are embracing the opportunity and the funds that are out there to put a distinctly Virginia stamp on health care reform,” Flores said. “And quietly the Commonwealth is emerging as a leader in reform.”

When money has been so tight, and there are savings to be had in health reform, states can’t afford to pass it up, Flores said. “The Virginia Health Reform Initiative should be an economic driver for Virginia,” he said.

Pam Silberman of the North Carolina Institute of Medicine said that her state is “still at the options and advice stage.” She said that policymakers are in the thick of the details of reform implementation.

“We have eight different work groups,” Silberman said. “Representatives of state agencies, insurance companies, agents, brokers, legislators, advocates — we have more than 260 people involved in one or more of the work groups.”

Again, financial motivators have pushed the action. “Our task has been, how can we leverage the grant opportunities under the Affordable Care Act to further existing policy goals?” Silberman said.

Her group has been contracted to get information to inform design of the health benefit exchange, which is expected to add between 500,000 and 600,000 newly insured North Carolinans, she said.

“We have identified the state laws that need to be changed to meet rate review for premiums,” Silberman said.

A lot of reform effort in North Carolina has focused on eligibility and enrollment systems, establishing the medical home concept and refining care coordination, particularly for chronic health conditions.

Allen said that New York’s medical home model has advanced quickly. “We’ve been working feverishly to get our medical home plan up,” Allen said. “We’re planning to enroll folks in health homes in October.”

Flores said that Virginia stands to benefit greatly from health reform, because 1 in 8 Virginians are uninsured. “That’s 1.1 million people,” he said. “It’s important to remember that we’re already incurring costs to pay for those uninsured, about $100 million each year over the last 10 years, and hospitals have provided about half a billion dollars to uninsured and underinsured in charity care.”

Those numbers are hard to argue with, given the federal money available to change that system, he said. But, he added, the arguments may just be starting.

“Because we’re starting at such a basic level, it has gone relatively well,” Flores said. “Tensions will come down the road as more decisions are made, when we get into decision-making mode.”

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