Shutdown Hasn’t Slowed State Leaders

SEATTLE — Despite the federal government shutdown, state health policy leaders have been as busy as ever.

“I’ve been enjoying these crazy times,” said José Montero, director of the Division of Public Health Services for New Hampshire’s Department of Health and Human Services.

Montero spoke in a plenary session at the 26th annual National Academy for State Health Policy conference here last week. The three-day event brought together hundreds of policymakers, administrators and experts from around the country.

Even though the conference halls were packed, a federal presence was conspicuously absent from this year’s event. The shutdown in Washington, D.C., prevented numerous federal officials from attending the conference, and it forced NASHP to make some last-minute substitutions to panels and presentations.

Despite the schedule changes and a few jokes at the government’s expense, conference attendees weren’t dwelling on the federal shutdown. With state health insurance exchanges in their first weeks of enrollment, there was far too much work to be done.

“We’ve been so busy,” said Julie Weinberg, director of the medical assistance division for the New Mexico Human Services Department. She noted that her staff is stretched thin trying to meet all the requirements of the Affordable Care Act.

New Mexico is one of 16 states operating a state-based health insurance exchange. Seven states are partnering with HHS to operate their exchanges, and the federal government is fully managing exchanges in 27 states.

In California, New Mexico and the other states running their own exchanges, health policy leaders have a lot on their plates.

Weinberg said in New Mexico, the ACA “has been as much a burden as it has been an inspiration.” She noted, “It’s a resource vacuum. It just sucks up all of my resources.”

Montero responded, “Drinking from a fire hose has never been easy. At the end of the day, that’s what [the ACA] is.”

ACA Implementation Still a Work in Progress

Montero and Weinberg weren’t alone in seeing significant challenges in the continued rollout of the health reform law. At sessions throughout the conference, speakers discussed technical problems, public resistance and other difficulties impeding with the ACA’s implementation.

Tricia Brooks, senior fellow at the Georgetown Health Policy Institute’s Center for Children and Families, said she believes states are on track to resolve the technical difficulties that plagued many health insurance exchanges in their first weeks of operation.

“I think we can nail these IT problems,” Brooks said. “I’m very optimistic that when we come out of the other end of this initial open enrollment period that we’ll be in much better shape.”

In a separate session, Linda Sheppard, special counsel and director of health care policy and analysis for the Kansas Insurance Department, discussed the need to better inform the public about the ACA and offer education about newly available services.

“Just because you get insurance cards into people’s hands doesn’t mean that they are going to use them properly or that they know how to use them,” Sheppard said.

Panelists agreed that the ACA has put significant pressure on states to adopt a lot of changes in a short time period. It’s no wonder that policy leaders are so busy.

In her keynote address, Susan Dentzer, senior policy adviser for the Robert Wood Johnson Foundation, said, “Yes, we’re drinking from a fire hose. Yes, it’s a long haul.” She added, “We have our work cut out for us in achieving better care.”

Panels Explore Information Technology, Other Topics

The ACA might have been the event headliner, but it wasn’t the only act in town. Panels and roundtable discussions also delved into behavioral health integration, Medicaid managed care and a range of other topics.

In a session on facilitating care coordination through health information technology, Linette Scott, chief medical information officer for the California Department of Health Care Services, discussed how the HITECH Act has fueled the adoption of electronic health record systems.

Scott said the HITECH Act is exciting because it doesn’t just promote technology for the sake of technology. Instead, she said, it promotes the use of technology to advance population health and improve care delivery.

Scott noted that states are following different paths to reach the same goal of sharing health data among providers. “If you look at the way we’re implementing HITECH in different states, it’s just as diverse as the Affordable Care Act,” she said.

For example, Scott noted that several California health care organizations, including Kaiser Permanente and Sutter Health, recently joined together to form the California Association for Health Information Exchange, or CAHIE. According to Scott, CAHIE aims to eliminate interoperability problems and advance health data exchange across California.

Although states have made significant progress on EHR adoption, Scott noted that much work remains to be done. “Just because you make the tools available doesn’t mean people know how to use them,” she said.

Laura Zaremba, director of the Illinois Office of Health Information Technology and a panelist in the session, said, “It’s incumbent on us to communicate how health IT is related to changes in the health care system.”

The Work Must Go On

As the NASHP conference drew to a close, the federal government still was shutdown and state health insurance exchanges still were open for business. What had states learned in the first few weeks of the exchanges?

“It’s too early to draw any lessons,” said Alan Weil, executive director of NASHP. “The reality is that this law is about so much more than operations, it’s about a major transformation in coverage.”

It was clear that the federal shutdown hadn’t slowed states’ progress on ACA implementation or a range of other health system changes. Throughout the three-day conference, state leaders shared their experiences and strategies for increasing efficiency, reducing costs and improving access to care.

“States are laboratories,” said New Mexico’s Weinberg. “We’re the laboratories for all sorts of things, for health care, the environment, education.” Weinberg noted that the best ideas in health care policy will disseminate across states and eventually become the law of the land. “It takes time to see that kind of change, it doesn’t happen overnight,” she said.

So what’s next for state leaders? Are there more health policy changes on the horizon?

According to Weil, the work of state health policy leaders will never be finished. “I often remind people that health policy didn’t begin with the Affordable Care Act, and it won’t end with it either,” he said.

RWJF’s Dentzer said, “If there’s ever a functional government in Washington, D.C., again in our lifetimes, there will be efforts to reform the health care system.”

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