Capitol Comments

States Opt Out of First Phase of Federal Health Reform

By Mikel Chavers, CSG Associate Editor

Some states won’t have anything to do with the first wave of federal health care reform—here comes a new round of challenges to the new federal law.

Under the first phase of the new law, states must decide if they will form new high-risk insurance pools for people with pre-existing medical conditions who are unable to get private health insurance—most have been denied coverage because of expensive medical conditions. The pools would allow these folks to get health insurance coverage and would be subsidized by the federal government. So far, Georgia and Nebraska said they won’t operate the new high-risk pools, according to the Atlanta Journal-Constitution and Forbes magazine.

Attorneys General Threaten Lawsuit Over 'Cornhusker Kickback'

A provision in the health care reform bill approved by the U.S. Senate on Christmas Eve could lead to a lawsuit.

Thirteen state attorneys general said in a letter to House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid they will sue if the provision to exempt Nebraska from paying Medicaid expenses other states would have to pay, according to the CNS News Service.

The “Cornhusker Kickback,” as the provision is known, forces taxpayers in other states to pay for the increase in Nebraska’s Medicaid population, the attorneys general say.

Different versions of health care reform have passed both houses of Congress and now must go to conference committee for reconciliation, followed by a final vote.

Read more about health care reform in the states in the January/February issue of Capitol Ideas, The Council of State Governments new magazine.

Health Reform Comes with Challenges, Needs for States

By Mary Branham

The epicenter of the health care debate is in Washington, D.C., these days, but the ripple effects of any Congressional action are sure to affect states.

And state officials have several priorities for any kind of reform, said Alan Weil, executive director of the National Academy for State Health Policy, an independent academy of state health policymakers.

He said leaders want to connect people with the services they need, bring better coordination and integration in the health care system, improve care for people with complex conditions, orient the health care system toward results and promote a more efficient health care system.

States Prescribe Varying Degrees of Health Reform

By Mikel Chavers

When Alan Weil talks about state health reform he always mentions the trilogy—Maine, Massachusetts and Vermont. As executive director for the National Academy for State Health Policy, he’s seen health reform initiatives that span the spectrum.

And a lot of it’s happening in the states, Weil said.

“It’s clear that the structure of the federal bill draws on state’s experience,” Weil said.

But the approaches are all different, even those in the trilogy, he said in a health policy workshop Thursday afternoon.

The Massachusetts health care reform plan, he said, tackled issues of coverage first, and will tackle cost later. Maine, on the other hand, is working on costs and coverage simultaneously, he said. In Vermont, the state started with chronic care management—there is a community-based organization designed to help people manage their chronic conditions, Weil said.

Building Blocks of Health Care Reform

By Mary Branham Dusenberry

Reforming the health care system won’t be easy, speakers at a workshop on the topic said Sunday.
But everybody knows change is coming as Congress considers options at the national level. In fact, some of those changes have been implemented as President Obama signed the Children’s Health Insurance Program Reauthorization Act Feb. 4.

The goal—getting more people insured—is admirable, Joan Gardner, executive director of State Services for Blue Cross Blue Shield, said. But plans for a national exchange, she said, could create problems. A government-run plan would create an uneven playing field between that plan and those provided in the private sector, she said.

But she acknowledged that changes need to be made.

Americans Sold on Electronic Medical Records, But Skeptical about Privacy and Cost

Three of four Americans say it is important to make the switch to electronic medical records, according to a public opinion poll released April 22 by the Kaiser Family Foundation, the Harvard School of Public Health and National Public Radio.

A majority of those polled said electronic medical records would improve the quality of medical care in general, as well as for themselves and their families. They also believe these records would prevent unnecessary care and medical errors.

The poll also revealed a healthy skepticism about the privacy of electronic medical records and implementation costs. Less than a quarter of the respondents believed electronic medical records would reduce health costs in general or for their families specifically. Nearly three in four were not confident that electronic medical records data would remain confidential.

The poll explores other questions about health care costs, care coordination and cost-effectiveness research.

Brian Russon, an industry strategist for the Health Solutions Group at Microsoft Corporation, will talk about health IT during the Technology Working Group session at the CSG Spring Meeting from 1 to 2:30 p.m. Saturday, May 16.  Also see the CSG Trends in America Special Report, Health Information Technology.

Going Where the Money Is ... Medicaid

Legislators are under the gun to balance state budgets and that means understanding the ins and outs of Medicaid, a major spending program in all states and territories.

The Council of State Governments has developed Medicaid 101: A Primer for State Legislators to help state legislators learn about Medicaid, the federal-state matching program that provides health insurance for one in four U.S. children, large numbers of elderly and people with disabilities and low-income parents.

Policy analysts at CSG with experience in administering state Medicaid programs provide the background and detail necessary for legislators to understand administrative testimony on Medicaid and to ask appropriate questions of state Medicaid officials. 

Stimulus Package to Help Medicaid Programs

The $825 billion economic recovery package presented by House Democrats includes $88 billion to increase the federal share of states’ Medicaid costs.

States would receive a bump of 4.9 percent in their federal matching rate for nine quarters, retroactive to October 2008. In addition, states could receive an additional increase in federal funds if they experience significant increases in unemployment rates.

In order to qualify for the increased Medicaid funds, states must not restrict Medicaid eligibility levels above those in place July 1, 2008. Restrictions prohibited include income eligibility or changes that make it more difficult for individuals to meet procedural requirements for enrollment or renewal.

The Center on Budget and Policy Priorities has released a preliminary analysis of the increases each state could expect in state fiscal years 2009, 2010 and 2011.  In addition, check out a comparison between House and Senate versions of the plan.

State, Federal Government Play Roles in Health Care Reform

By Crady deGolian

The recent presidential election will likely bring changes to the nation’s health care system. 

Though it is unclear at this point what those changes will be, it is certain that state governments will be at the forefront of implementing them. Catherine Hess, senior program director at the National Academy for State Health Policy, discussed the roles of federal and state governments in reforming health care during the Health Policy Task Force session during The Council of State Governments annual meeting Dec. 5.

Hess pointed out that while the U.S. ranks first among developed nations in dollars spent on health care, the country lags behind these same nations in innovations to improve the quality and efficiency of outcomes.  That means state governments will play an essential role in improving the nation’s health care system, she said.

Institute of Medicine Recommends State Policies on Smoking

By Ann Kelly, CSG associate director of health policy

A recent policy blueprint from the Institute of Medicine points to policies states can adopt to help people quit smoking and prevent youth from ever starting to smoke.  Without such aggressive policy action, the institute predicts the U.S. smoking rates will not decline further.

Helping people who are motivated to try and quit smoking is one of seven key policies included since safe and effective treatments, including medications, are available and insurance coverage for these treatments is increasing. While it is unlikely that an individual will quit smoking with one treatment, using effective cessation treatments population-wide can significantly reduce smoking rates and ultimately bring about savings in health care and other costs.