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Collaboration between States, Federal
Government key to Health Care Reform
Newswise — In order to achieve comprehensive health care
reform, states cannot do it alone. States
and the federal government must partner and
collaborate to overcome barriers and
challenges to create high-quality,
affordable health care, according to the
authors of a commentary in the October 22/29
issue of JAMA, a theme issue on the
Health of the Nation.
Ezekiel Emanuel, M.D., Ph.D., of the National Institutes of
Health, Bethesda, Md., presented the
commentary at a JAMA media briefing
at the National Press Club in Washington,
D.C.
Dr. Emanuel and co-author U.S. Senator Ron Wyden, J.D.,
write that when Massachusetts passed a
health reform bill in 2006, numerous state
legislatures met and sought to enact
legislation providing health care for all
state residents, but not one was successful.
“States cannot reform health care on their own. Governors
and state legislators, in concert with
federal officials, must reconceive
federal-state health care relations so that
together they can meet the health care needs
of all Americans.”
The barriers to states implementing substantial health care
changes on their own are substantial.
They include programs and factors out of states’ control:
changing federal tax laws related to health
insurance, self-insured employers regulated
by ERISA (Employee Retirement Income
Security Act), modifying Medicare and
Medicaid, and the health coverage programs
for federal employees in the state, the
military, and veterans.
Other barriers to state reform are the substantial costs
with financing reform and reforming the
health care delivery system.
In fact, excluding Massachusetts' health reform bill, which
is still in evolution, every time states
have enacted a comprehensive reform effort
it has failed.
Although states cannot make the changes alone, they can
play three critical roles in health care
reform. They can be facilitators,
regulators, and innovators, the authors
write. “First, states should be facilitators
by creating and overseeing insurance
exchanges.
"They are the logical place to develop
insurance exchanges, manage enrollment, help
state residents choose from a variety of
plans to meet their needs, and provide
informational materials to consumers and
employers.
"In a new federal-state health partnership,
the states should serve as the point of
contact for self-employed individuals,
workers in small businesses, and those who
would be part of a reformed individual
market.”
“Second, states should be important regulators. The logical
place to regulate health insurance plans is
at the state level. States oversee these
plans today through insurance commissioners
in each state.
"They should continue to protect consumers in a new
federal-state health partnership, ensuring
that plans sold in the state prohibit
discrimination against individuals with
preexisting illnesses, provide for fair
marketing practices, and oversee grievances
and appeals. States should oversee the
development of standardized common claim
forms and uniform billing practices to
reduce administrative waste.”
“Third, states should be important innovators,” they write.
“… states should be granted a broad waiver
authority to develop innovative programs
tailored to meet the unique needs of their
citizens. In addition, neither the federal
government nor business has taken sufficient
initiative regarding wellness and prevention
programs.
"States can develop novel programs around wellness and
prevention that focus on the entire state
population. … Plans could also push for the
development of more effective uses of health
information technologies. States could
require insurance plans that enroll state
workers to open electronic medical records
for them at the expense of the private
insurer.”
“The American public wants what only the federal government
can guarantee—that all Americans, regardless
of where they reside or work or any other
characteristic, have high-quality,
affordable health care.
"It is impossible to have one level of government oversee
all aspects of health care for 300 million
Americans. States will and should have a
role in any comprehensive health care
reform, but they cannot do it alone. The
federal government will have to take
initiative to achieve sustainable and
successful reform,” the authors conclude.
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