The federal health reform law is only the starting point for achieving health care access for all Americans. Many states are already moving forward, not only on implementing the basic provisions of the Affordable Care Act  in their states, but are also planning how to build on its framework to further expand coverage and rein in costs for their residents. The following are a few models of implementation and comprehensive reform underway.
- Connecticut is one of the leaders in moving toward comprehensive universal health care coverage. Their bold and innovative enactment of Sustinet in 2009  (HB 6600 ) created multiple self-insured coverage pools, providing businesses and individuals with new insurance options. This included a new public option whereby coverage pools will provide the leverage necessary to implement system innovations to drive down cost and improve quality on a large scale.
SustiNet will be rolled out over the next 4 - 6 years . By 2014, it is estimated that 98 percent of residents will be insured with a comprehensive benefits package. Sustinet will give every  patient a medical home, ratings will not be based on age, gender or health status, and coverage will be guaranteed for chronic or pre-existing conditions. 2010 is a crucial year for its initial phase. The 11-member SustiNet Health Partnership Board  has the responsibility for implementing SustiNet with the support of five committees and three task forces, a diverse group of more than 160 Connecticut experts volunteering their time and skills. By January 1, 2011 the Board must present a final report to the state Legislature with specific recommendations for implementation. State lawmakers will need to pass legislation in 2011 to allow the SustiNet Health Plan to be offered in 2012.
- Oregon was in the forefront of laying the groundwork to implement federal reform with the 2009 passage of HB 2009 , which created the Oregon Health Authority  (OHA) and its oversight and policy making body, the Oregon Health Policy Board  (OHPB). Now in the planning stages, the goal in Oregon is to realign most health-related programs  in the state by joining them together under one administrative and operational umbrella by July 2011. In addition to developing a plan to provide every Oregonian with affordable, quality health care, addressing health care workforce issues and overseeing the interaction between state and federal health reform, OHA will also create the Oregon Health Insurance Exchange, a one-stop shop to compare and purchase health insurance plans.
Included in the creation of OHA and OHPB was a transition project to provide oversight and guidance in the transition from the current Department of Human Services to OHA. The Transition Project  will help identify barriers to a smooth transition of business processes, provide a forum for exchanging ideas and serve to establish open lines for two-way communication. Members of its Executive Steering Committee include provider, consumer, advocate, county, employee union, tribe and other representatives.
- Vermont is taking a unique approach in addressing comprehensive health care reform. SB 88, an Act Relating to Financing and Universal Access to Health Care in Vermont  has as its goal the design of a single comprehensive health care system. What is particularly intriguing about the legislation is that it instructs the state’s Joint Legislative Commission on Health Care Reform  to prepare at least three comprehensive health care system design options including plans for implementation by February of 2011. From there, it will be up to the Legislature to choose and enact one of these systems with an implementation goal of July 2012. SB 88 established a requirement to look at three options  — a single payer system, a pubic option and continuation of the current system. The study will update past studies and provide comprehensive data on the financing mechanisms, costs and details associated with all three options.
Should the Legislature decide to implement the single payer option, it would need a waiver from the federal government to move forward. As the timeline in the Affordable Care Act sets 2017 as the first opportunity for states to apply for such a waiver, it could create some momentum in Congress to amend the timeline to an earlier date.
- Thanks to the sponsorship of Maine Rep. Sharon Treat, HP1262  established the Joint Select Committee on Health Care Reform Opportunities and Implementation . It is a 17 member committee of Senators and Representatives created to study federal health care reform legislation, determine the State's opportunities for health care reform and the state's role in implementation of the federal legislation. The Committee’s first meeting  on May 20th included a discussion of goals and priorities, an overview of the Affordable Care Act, the state’s role in implementation and an overview of current Maine coverage laws. In subsequent meetings, the committee will examine  how the state will oversee its health insurance exchange, opportunities to conduct pilot projects on cost containment, payment reform, and the impact of the federal law on the State’s MaineCare program . By no later than November 3, 2010, the Committee will submit a report of its findings and recommendations that should include suggestions for legislation in its 2011 session.
Most other states have created commissions or task forces to move forward on implementing federal reforms. See listings of these state efforts at PSN’s website section on: State Models for Implementation 
Universal Health Care Foundation of Connecticut 
The Vermont Legislature Commission on Health Care Reform 
Oregon Health Policy Board 
Maine Joint Select Committee on Health Care Reform Opportunities 
Progressive States Network: Failure of Right Wing Obstruction in the States 
Even as most states are moving forward with implementation of federal health reform, right-wing efforts to undermine the law at the state level through bills supposedly opting out of parts of the federal law have failed across the nation.
Early this year, the health insurance industry-funded American Legislative Exchange Council (ALEC) claimed that over 40 individual state legislatures have "defend[ed] health care choice" by being witness to the proposed or actual introduction of their model legislation intending to attempt to nullify the recently passed federal reforms in the Patient Protection and Affordable Care Act.
Well, the results are largely in and, as we document at www.alecfail.com , state legislatures across the nation have overwhelmingly rejected ALEC’s bills:
ALEC style bills or proposed constitutional amendments have failed in Alabama, Alaska, Arkansas, Colorado, Delaware, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Mississippi, Oklahoma, Nebraska, New Hampshire, New Mexico, North Dakota, South Dakota, Tennessee, West Virginia, Washington, Wisconsin, and Wyoming (highlighted in red with a FAIL stamp).
In other states where ALEC has claimed success, such as Montana, Rhode Island, and Texas, health care nullification bills have yet to even be introduced.
As efforts to implement national health reform move forward across the country, Progressive States Network is highlighting resources from many of our national and state partners at our website page: State Implementation of Federal Reform: Resources 
How Health Reform Will Benefit the American People: Given the misinformation about the federal health reform law promoted by the rightwing, many of the resources help highlight the gains to American health consumers and the overall economy from passage of the law:
- The Impact of Health Reform on Health System Spending  (Commonwealth Fund)- Coauthored by Center for American Progress Senior Fellow and Harvard economist David Cutler, this study estimates that the net combination of provisions in the new law will reduce health care spending by $590 billion over 2010—2019 and lower premiums by nearly $2,000 per family.
- What Will the New Health Reform Law Do in the First Year (April 2010)  (Families USA)- discusses how health reform will help people with pre-existing conditions, young adults, people on Medicare, small businesses, community health centers, and others in its first year.
- How Will Health Reform Impact Young Adults?  (Kaiser Family Foundation's Commission on Medicaid and the Uninsured) - explains the key ways in which the new law will affect adults ages 19 to 29, an age group that includes 13.7 million uninsured people who comprise nearly a third of the overall uninsured populations.
- Medicaid Coverage and Spending in Health Reform: National and State-By-State Results for  Adults at  or Below 133% FPL  (Kaiser Family Foundation) - this analysis and video presentation details how the expansion of Medicaid under the health reform law will significantly increase the number of people covered and reduce the uninsured in states across the country, with the federal government picking up the vast majority of the cost.
- The Check Is in the Mail for Some Medicare Part D Enrollees  - (Commonwealth Fund) The Department of Health and Human Services announced that $250 checks will be automatically distributed beginning June 1 to seniors who have fallen into the "doughnut hole" of their Medicare Part D prescription drug plans. HHS Secretray Sebelius said that about 80,000 seniors initially will receive their checks. Some 4 million seniors should qualify by year’s end.
Resources for Implementing Reform: Other resources included on the site highlight tools and resources for implementing reform:
- High-Risk Pool Programs Take a Step Forward  (Department of Health and Human Services) - details the 43 states that as of April 30, 2010 had told the Department of Health and Human Services how they plan to participate in high-risk pool programs: 28 indicating they would run a state-based high risk pool program, and 15 saying they would let HHS administer the high-risk program for their state's residents.
- Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans  (HealthReform.gov) - details of the implications of the rules for grandfathering regulation of employer health care plans. While health plans that existed on March 23, 2010 allows insurers and employers to make routine changes without losing their grandfather status, plans will lose that status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers — and as a result consumers in plans that make such changes will gain new consumer protections.
- Questions About Health Insurance Exchanges  (Kaiser Family Foundation) - Explains how exchanges will initially serve primarily individuals purchasing insurance on their own and smaller employers, but states will have the option of opening Exchanges to larger employers a few years after implementation. This summary provides responses to questions about the purpose and function of Exchanges and how they relate to regulation of the insurance market.
- Key Health Insurance Market Reforms Not Achievable without an Individual Mandate (April 7, 2010)  (Center on Budget and Policy Priorities) — Details how insurance reforms without a mandate would encourage some people to wait until they are sick to buy coverage, raising premiums for everyone else. The individual mandate will help keep premiums at a more reasonable level.
- Early Medicaid Expansions under Health Reform  (Families USA) -This report discusses how states can expand their Medicaid programs earlier than federal reform requires them to do so (2014), and why they should. Starting in April 2010, states will be able to phase in Medicaid expansion through a state amendment process.
Progressive States Network - State Implementation of Federal Reform: Resources 
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