According to the report, states are a key testing ground for new approaches and their innovations are likely to play prominently in any proposals put forth by future administrations. Says Martinez-Vidal, "The answers states identify and implement will provide key insights for national health reform."
State approaches to reform vary considerably, often depending on the political and fiscal environment; demographic characteristics, insurance market dynamics, and other economic variables also impact a state's capacity to act. Yet, according to the report, almost universally states are considering health care reform in a very pragmatic way.
Says Martinez-Vidal, "A single-payer system is generally not considered a politically viable option; but, neither are reforms that rely completely on a free market, consumer-driven health care system. Instead, most state reforms look to politically feasible proposals that build on the current, mixed, public-private health insurance system."
Overall, states' reform activities can be grouped into three general categories:
-- Comprehensive reforms like those passed Massachusetts and Vermont in 2006, Maine's Dirigo plan, and new proposals that California, Pennsylvania, and New Mexico have been working on this past year;
-- Substantial reforms that expand coverage, ensure private market reforms and/or launch new purchasing mechanisms, such as Washington's legislation providing access to coverage for all children by 2010, and begin a premium subsidy program for families; and
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