OP-ED

States Should Have Flexibility to Develop Own Health Reform Plans

One issue has generated little discussion during the heated health care reform debate: whether states should have the right to develop their own approaches to universal coverage.

The Health Security for New Mexicans Campaign wants to see language included in the national proposal that gives states flexibility to develop their own approaches to solving rising health care costs and growing numbers of uninsured.

The focus of current health care reform proposals is to create “insurance market exchanges.” These one-stop-shopping insurance exchanges must offer consumers — primarily the uninsured — choices of different insurance products, including some type of public option. A less than robust public option is in the proposal passed by the House of Representatives. The Senate is in the process of negotiating an alternative to the House version.

Unfortunately, the health care reform debate has skirted the issue of whether states can take a different path that reaches the same goals. States always have been laboratories for innovation. Women’s suffrage, civil rights, child labor and minimum-wage laws were developed in the states first and then became federal law. Why shouldn’t states be allowed to continue that role in health care reform?

If a state can develop an approach that is not based on the insurance market exchange model, an approach that still provides comprehensive health coverage for its residents and contains rising health care costs, why shouldn’t it be encouraged to do so?

The recently passed House bill contains no language enabling states to develop anything other than an insurance market exchange. The merged Senate bill now under consideration mandates that by 2014, states must set up an insurance market exchange and experiment with it for three years before requesting any waivers.

Why should states be forced to go through a long, expensive, complex and time-consuming process when they already may be working on approaches more appropriate to their circumstances?

In New Mexico, the Health Security Act offers a different solution from that based on an insurance market exchange. It is a “home-grown” solution that has earned enormous public support — 146 diverse organizations are part of our coalition, and 32 New Mexico counties and municipalities have passed resolutions endorsing it.

The Health Security Act would enable New Mexico to set up its own health care plan that automatically covers most New Mexicans, provides comprehensive benefits and guarantees freedom of choice of doctor even across state lines.

Instead of creating a system of competing insurance plans, each with different provider networks, this proposal would shift the role of private insurance companies to provide supplementary coverage – as they do with the original Medicare program. Any individual, employer or group wishing to purchase additional coverage could do so. A non-governmental, geographically representative citizens’ board would be in charge of the plan.

Two separate studies have concluded that if such a health plan were established in New Mexico, health care costs would be reduced by hundreds of millions, if not billions, of dollars within five years.

Why is this so? Because this approach simplifies a very complex private insurance system with its hundreds of policies, different benefits, co-pays and deductibles, all of which affect administrative overhead of doctors, hospitals and clinics – and which, in turn, negatively affect health care costs.

In a state such as ours, with a small population, it makes economic sense for most residents to be covered under one health risk pool.

Coalitions in other states — California, Minnesota, New York, Pennsylvania, Washington and Oregon, to name a few — have been working on proposals that are not based on an insurance market exchange and are adapted to the particular needs of those states.

Acknowledging these developments, the National Conference of State Legislators recently passed a resolution containing a provision asking that states be allowed to create solutions that go beyond any federal requirements. New Mexico was counted as one of the resolution’s supporters.

In addition, New Mexico State Sen. Dede Feldman and others from the House and Senate sent a letter to our five-member congressional delegation, which included a request that states be given flexibility to develop their own comprehensive plans.

Health care reform should clearly encourage state experimentation. Aside from the need for state flexibility language in the national legislation, the Health Security for New Mexican Campaign believes states deciding to develop their own health plans also should have the right to access the same federal dollars as those states choosing to set up their own insurance market exchanges.

At this critical juncture, Congress needs to tackle this issue.

Bartlett and Aguilar are the chair and vice-chair, respectively, of the Health Security for New Mexicans Campaign.

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GregHealth care workerBettycalciumR Donnelly Recent comment authors
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Greg
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Greg

An important milestone has been made in Pennsylvania. PA Democrats have unanimously endorsed Single-Payer healthcare reform. Republicans and Democrats in the state Senate and House are behind it and Governor Rendell has promised to sign it if and when it comes to his desk. This is the type of program that our country should have been working for but hasn’t, publicly funded, privately delivered health care.
http://healthcare4allpa.org/

Health care worker
Guest
Health care worker

Also, why can different states not learn more Masscussets and implement the successfully ideas or concepts at Federal level.

Health care worker
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Health care worker

I think giving stats the flexibility to devleop their own health care reform plans have its owns pros and cons.
Pros:
1.At State level there is more control on state budgetary priorities.
2. State Government can develop programs based on demographics, diversity, etc. depending on state’s population need.
Cons:
1. Lack of standardization and thus maintainance becomes difficult.
2. Why would we want 50 state governments to spend time, when this is a federal level priority and should be dealt at federal government level.
What every happens, I think health care reform in important and inevitable.

Betty
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Betty

Interesting article and comments. I’m glad to see that Indiana seems to have found a very good solution for health care. There is a report just out by CIGNA that shows empirical data regarding CDHP’s. It showed increased levels of care and reduced health care costs. I’ve been using a book called “Bend the Health Care Trend” to better understand what CDHP’s are about and how they work. They seem to be the future of health care.

calcium
Guest

Hello
I like your point about own health reform plans for states.I agree with your points about it in this post.I think this would be very helpful in every way.Thank you very much for such good post.

R Donnelly
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R Donnelly

States should have some wiggle room. Just like each individual is different, states have their own needs and special situations. We are spending a lot on health care now. I understand that a public option is very expensive, but each state knows their specific needed reforms better than the feds. It is clear though that if we do not notify the health care industry that they are not providing for the needs of the people they have us to answer to. Government is our only tool to speak out and we have to make sure the health care industry does… Read more »

Peter
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Peter

“Look no farther than Indiana for an example of intelligent, fiscally responsible reform:”
Really? So how much did this “reform” lower system costs? Any idiot can buy a high deductible heath plan to lower their premium, but it just transfers risk from the insurance comnpany to the insured. Rearranging the Titanic financial deck chairs has nothing to do with controlling costs.

R.D. Quinn
Guest

Yikes, just what we need fifty different solutions composed and managed by the politicians of fifty different states. The states and their mandates and their various insurance laws and regulations are part of the problem not the solution. Take a look at how the states manage the health benefits for their own employees and you will see overly generous plans, mismanagement of funds or no funding and out of control costs driven in large part by public unions. I have evaluated the health benefits for state workers for three different governors in the state where I live and I am… Read more »

Mike
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Mike

Look no farther than Indiana for an example of intelligent, fiscally responsible reform: “Governor Daniels, in his first term, won bipartisan support for a program known as Healthy Indiana, which provides health insurance for Hoosiers who aren’t poor enough to qualify for Medicaid but earn too little to afford buying coverage for themselves. So far, 50,000 residents have signed up for the program, under which the state contributes up to $1,100 each year to each enrollee’s individual health savings account. Participants also contribute according to their income, and when the account is depleted, a catastrophic insurance plan kicks in to… Read more »

Peter
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Peter

“My wife and I have found a solution that seems to work for us…Health care beyond America’s borders.” Yup, I’ve also decided to abandon the U.S. health insurance system – it’s too broke for the corporate funded politicians to know anything about how to fix it – even if they cared. I cancelled my insurance years ago and have since banked the premiums. I can go to Thailand or India, even Canada, for my healthcare and get a vacation thrown in as well. Looking at the present system from the outside is a little like observing the inmates and staff… Read more »

Norris Hall
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Norris Hall

If the recent debate on health care has taught us anything…it’s that the consumer is not in the driver’s seat on this. Drug Companies, Insurance companies, Hospitals, and doctors…the ones that set the pricing for medical care…all have their high paid lobbyist prowling the halls of congress, dishing promises of golf outings, campaign contributions, future employment and other goodies to the hungry members of congress. As long as money is being waved in front of our elected representatives…don’t expect them to pay much attention to voters. After all even elections are won by slick ads that cost money…so follow the… Read more »

Dan Smith
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Dan Smith

I totally agree with your column. The Federal Government is overstepping on the healthcare issue. The Feds should just make law changes to end the practices of the insurance companies that deny health insurance and provide a subsidy to help the disadvantaged purchase health insurance. The states can develop mechanisms to control costs. For example some may use a state Medical PSC to control costs. This is how a state Medical PSC could work: 1. PSC’s will determine the basic cost of each Medical Charge Code used by providers to bill insurance. If the current medical charge code manual is… Read more »

Jabbar Fazeli, MD
Guest

Government inflexibility and Healthcare reform At the peak of the national debate on healthcare reform a central fear of ordinary people and healthcare providers remain unaddressed and rarely discussed. Would bigger government role in healthcare make our government even more inflexible in correcting system failures that impact patient care? I submit that the government’s past conduct in fixing existing issues is the barometer for things to come. Issues like the VA’s prior authorization for PCP visits in nursing homes (In some nursing home contracts the VA mandates that they pre-approve most, if not all, visits by the patients’ own PCP… Read more »

MD as HELL
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MD as HELL

States should not be bowing to the feds for healthcare reform. States rights should preclude massive revenue transfers from state to state.