No Longer Waiting for Feds, States Jumpstart Health Reform

Joe Cantlupe, for HealthLeaders Media , February 17, 2010

More than two dozen states have launched healthcare reform initiatives, but most are strapped financially and are unlikely to undertake major reform while federal legislation is stalled on Capitol Hill, says a top health official for the National Conference of State Legislatures.

"A majority of states are clearly going to wait and see what the federal government is going to do," says Richard Cauchi, health program director for the NCSL.

That doesn't mean the states have been inactive, Cauchi adds. At least 26 states are considering healthcare regulations ranging from management of chronic disease to healthcare quality improvements, as well as insurance programs for children, he says.

Other programs considered are special grants for needy individuals, a special insurance program for state employees, Medicaid expansion and Medicaid buy-in plans, and changing to a single-payer system.

"States are very active in health changes and innovation in one sense–that there is legislation being considered to do all manner of things with health reform, but it's not comprehensive or universal," he says. Comprehensive reform entails achieving near universal coverage of state residents.

Missouri is one state that is considering comprehensive coverage. State lawmakers in January introduced comprehensive legislation that would establish the Missouri Universal Health Insurance Act to provide "comprehensive and necessary healthcare services" for Missouri residents.

Legislation would provide comprehensive health, mental health, and dental care for residents, according to the state legislation. In Maryland, a bill was introduced that would require the health system to provide healthcare services "to all residents of the state under a single system that is not dependent on employment."

However, states are also facing time and fiscal barriers. Budget constraints and limited days in which state lawmakers are in legislative session have contributed to the lack of widespread action, he says.

"The recession has made it harder for states to finance programs to cover the uninsured," the states' organization said.

In November 2009, states closed a cumulative budget gap of $145.9 billion with new gaps reported and predicted to continue through 2012. For some states, however, there is a feeling "why should we wait and they are not shy about trying something," according to Cauchi.

Within the past week, Cauchi says Colorado officials announced a major package to strengthen the state's healthcare system. State officials said they were focusing on cost-savings, improvements to public and private insurance programs, and better care for women.

"The demands on our healthcare system and the costs of providing care continue to increase for Colorado families, businesses, and providers, " said Gov. Bill Ritter Jr. in a speech before the Colorado Health Foundation on Feb. 11. "We can't wait for Washington to act and we aren't."

States, such as Colorado, may be moving ahead with some healthcare reform, but most are still far from Massachusetts, which has an individual mandate. Maine and Vermont are the exceptions. They have their own versions of comprehensive health reform, Cauchi said.

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