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Report Lists Key Policy Questions Facing State, National Health Reform
Date:2/8/2008

ve shown an enormous capacity to work through different design scenarios and are determined to finding answers," says Enrique Martinez-Vidal, director of the State Coverage Initiatives program and a lead author of the report. "They don't really have a choice but to keep working on these problems. The status quo just isn't working and there isn't much hope of Federal help in the immediate future."

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

-- Increme
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SOURCE AcademyHealth
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