Word: reformations
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...much power federal health reform gives to states to manage exchanges - as envisioned in the Baucus bill - is a key element for controlling the cost of private health insurance for individuals and small businesses. "It's not whether they can or can't [establish an exchange]," says Alan Weil, executive director of the National Academy for State Health Policy, a nonpartisan, nonprofit organization. "It's whether they will do it in an active way. An insurance exchange could just be a website that posts products, and you could do that with two people and an IT person...
...Some states that have already tackled substantial health reform could be better positioned than others. Massachusetts, the only state to have enacted universal health-care reform, already has a working exchange and many of the insurance-market reforms called for in federal legislation (such as guaranteeing coverage to anyone who applies and prohibiting premium pricing based on health status). Cantwell based her amendment on a program that already exists in her home state of Washington; called Basic Health Plan, it pools non-Medicaid-eligible low-income residents, steering them into less costly managed-care plans. Critics point out that premiums...
...Earlier this year, the Connecticut legislature overrode a governor's veto to pass a comprehensive health-reform bill that aims to provide health insurance to 98% of its residents by 2014, in part through the creation of a statewide self-insured health plan. Derek Slap, a spokesman for the president of the state senate, says, "The hope is that it will dovetail very nicely with health reform nationally." Rhode Island, which has some of the most stringent insurance-market regulations in the country, already has guaranteed issue in the small group market (requiring insurers to accept all applicants) and strict...
...other states, including many in the South and Midwest, have not attempted such bold reform, meaning they will probably be slower to adapt to potential new responsibilities. There is also a concern among some policy experts that state legislators, who could have a lot of control over reform implementation, are too beholden to local interest groups like small insurers and health systems. "There's no question that lobbyists win cheaper on the state level," says Len Nichols, a health economist at the New America Foundation. "With a set of [Arkansas] Razorbacks tickets for one weekend and they...
...States also may be better at innovating on delivery and payment reform, working with local health-care providers to make care more efficient and affordable. "It's very hard for the feds to experiment," says Rhode Island's Koller. "What we can do much better is work with providers and work with the delivery system...