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Volume 12 Number 104 Lead Report: Access States continue to forge ahead with health care reforms, but are facing tough questions about how to keep the programs financially sustainable and how to maintain political support for them, according to panelists speaking May 30 at a briefing sponsored by the Alliance for Health Reform. Spurred by rising numbers of residents without health insurance and the related problem of employers' dropping coverage, more than a dozen states are considering or have recently approved health care reform legislation, and lessons from reforms implemented or about to be implemented already are becoming apparent, panelists said. States are acting on the issue, because many have healthy budgets for the first time in years and because federal action on health reform seems remote for the time being, panelists said. Maine, Massachusetts, and Vermont have adopted or are about to adopt coverage programs, according to Enrique Martinez-Vidal, acting director of State Coverage Initiatives, a program of the Robert Wood Johnson Foundation. Washington state approved health reform legislation two weeks ago and will soon begin implementing it, he added. Colorado, Oregon, and New Jersey likely will be next in line with health reform packages clearing their legislatures. Donna Cooper, secretary of the Governor's Office of Policy and Planning in Pennsylvania, said the legislature there likely will consider a reform package this fall. Building on Current System When crafting reforms, most states are building on Medicaid, the State Children's Health Insurance Program, and the employer-coverage system, said Joy Johnson Wilson, health policy director at the National Conference of State Legislatures. Programs created by states generally address gaps in coverage left by the current health care system, she added. For example, Wilson said, state initiatives often target several populations without insurance coverage, including children; those 19-30 years old who may be working but do not get coverage through their job; those with chronic illnesses; and small businesses, part-time workers and the self-employed. Krista Donahue, chief of policy for the Illinois Department of Healthcare and Family Services, said that Illinois is considering legislation to cover several groups now without insurance, including about 183,000 uninsured parents whose children have coverage and individuals aged 19-30, who would be allowed to stay in their parents' plans if their parents have health insurance. The Illinois plan also contains a push for electronic medical records; dissemination of best practices; a task force to make recommendations on pay-for-performance; and integration of disease management into the health care system, Donahue said. Cooper said the Pennsylvania plan contains about "90 percent" of what is in the Illinois legislation. She said lawmakers are debating such issues as where to set financial subsidies for those who cannot afford coverage on their own and whether a tax assessment on employers not offering coverage is fair. Competition Aspect Some business owners providing health insurance to their workers are angry that competitors not offering coverage have an economic advantage over them, Cooper said. The 2008 presidential race also is playing a part in the debate, with lawmakers trying to gauge how implementing reforms will affect the race for president in the state, she added. Martinez-Vidal said legislation authorizing state health reforms often is vague, and states implementing such programs now must "make it work on the ground." Challenges facing states implementing reform plans are how to maintain financing for them; how to ensure health care coverage provided is affordable, and how to enforce individual and/or employer coverage mandates, he said. Some of the programs always have been unpopular with a segment of state legislators, and lawmakers in some cases have continued to work against the programs after they are implemented, Martinez-Vidal said. Leadership from high-ranking state officials and funding sources are key to the success of most state health reform plans, he added. The Employee Retirement Income Security Act also is hampering state reform efforts, but there currently is no coordinated effort among states to ask the federal government to amend ERISA to make reforms easier, Johnson Wilson said. More information is available.
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