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Access A bipartisan, bicameral group of lawmakers Jan. 17 introduced bills to provide federal grants to states to carry out reforms to reduce the number of individuals without health insurance coverage. The introduction of the legislation is an indication that states have become laboratories for health care reform efforts and that Congress is unlikely to consider sweeping reforms in the next two years, sponsors of the measures said at a press briefing. The bills would establish a "State Health Innovation Commission" that would review state health reform proposals. The proposals then would be subject to approval by Congress. The review process would take about six months, bill supporters said. Proposals spanning the political spectrum likely will be spawned by the bills, from single-payer types plans to those using the tax code to provide coverage to the uninsured, to expansion of Medicaid or State Children's Health Insurance Program plans, they said. The number of Americans without health insurance reached 46.6 million in 2005, according to the Census Bureau. Congressional Approval Needed The bill would provide as much as $4 million for the operation of the commission, but the amount of money available to states would depend on the type and scope of plans submitted by states, they said. The commission would act in much the same way as the Base Realignment and Closure Commission does, as votes would be taken on numerous state health reform plans as part of a package, they added. After five years, the commission would report to Congress about state efforts and recommend possible additional congressional action. The Senate bill, the proposed Health Partnership Act (bill number unavailable), was introduced by Sens. Jeff Bingaman (D-N.M.) and George Voinovich (R-Ohio). The House bill, the proposed Health Partnership Through Creative Federalism Act (H.R. 506), was introduced by Reps. Tammy Baldwin (D-Wis.), John Tierney (D-Mass.), and Tom Price (R-Ga.). Both bills also were introduced in the 109th Congress. Health care lobbyists and policy analysts have said helping reduce the number of uninsured Americans may be a topic on which Democrats and Republicans could work together in the 110th Congress, although the federal budget deficit likely would prevent major proposals from becoming law. State Initiatives A report issued Jan. 17 by the Robert Wood Johnson Foundation said states are motivated to provide coverage for the uninsured for a variety of reasons, including declines in employer-sponsored health insurance, improved state economies with increased state revenues, and the lack of national action. The report, State of the States 2007, Building Hope, Raising Expectations, found that more than a dozen states have enacted innovative policies to expand coverage; they include comprehensive health care reform (Massachusetts, Vermont, Maine) , public-private partnerships (Arkansas, Montana, New Mexico, Oklahoma, Rhode Island, Tennessee, Utah), and initiatives to cover all children (Illinois, Pennsylvania). California Gov. Arnold Schwarzenegger (R) Jan. 8 unveiled a health care reform plan that would require every one of the state's 6.5 million uninsured residents to have health insurance, and use a combination of funds from individuals, employers, providers, hospitals, and state and federal government to pay the $12 billion price tag. "States are facing a 'perfect storm' with health care," said State Coverage Initiatives Acting Director Enrique Martinez-Vidal, "and that has provided governors and state legislators with the political will necessary to tackle the problem. States have been fertile testing grounds for new reforms and have proven that bipartisan compromise is possible." The state coverage initiatives program is a national program of the Robert Wood Johnson Foundation. Valuable Information Lawmakers said while individually they may disagree with the best way to expand health insurance, funding state initiatives will provide valuable information about covering the uninsured. "The truth is, dealing with this problem between now and the [2008] election is not realistic," Bingaman said of a comprehensive solution being considered by Congress. "While there are many health reform bills on the table, including my own preference for a single payer plan, it's clear to me, and has been for some time, that no single approach has enough support to become law," Baldwin told reporters. Price said he favored the bill because "one-size fits all doesn't work in health care . . . and it's not politically feasible. What is right for one state may not be right for another." "For too many years, I have listened to my colleagues on both sides of the aisle talk about the rising cost of health care and the growing number of uninsured. And for too many years, I've seen little progress here at the federal level," Voinovich said. The bill "aims to break the logjam and allow states to experiment with health care reform options," he added. "Our hope is the bill will provide a platform from which we can have a thoughtful conversation about comprehensive health care reform here in Washington." The Robert Wood Johnson report is available on the Web at http://www.statecoverage.net/pdf/stateofstates2007.pdf
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