Word: small
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Dates: during 2000-2009
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...already hurting state budgets could be strained by the expansion of the Medicaid program that is proposed in all the health bills, there are other key responsibilities that could fall to them under the Baucus bill. Most important, the all-important exchanges - Web-accessible marketplaces in which individuals and small groups could compare and shop for private insurance - would be established state by state. By contrast, the House bill would create a national exchange. Instead of a national public insurance plan - the controversial "public option" that is included in both the Senate Health, Education, Labor and Finance Committee bill...
...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...
...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 limits on how insurance companies can set premium rates based on health status. "Changing the underwriting laws will be relatively easy for us," says Chris Koller, Rhode Island's insurance commissioner...
...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've got it." (See what health-care reform really means...
...Still, Nichols is among the policy experts who believe that since states already have responsibility for regulating health insurance in the individual and small-group market - the target of most insurance reforms in federal legislation - they will be well poised to enforce whatever new federal regulations are put in place. After all, compared to the relatively simple new rules on the table - insurers wouldn't be able to exclude treatments for pre-existing conditions and would have to sell insurance to anyone who applied for it - many current state insurance regulations are a mishmash of complex formulas and exclusions. "What...