State Leaders Weigh in on Final Health Care Reform Bill

State Leaders Weigh in on Final Health Care Reform Bill

Thursday, January 7, 2010



By: Enzo Pastore

State Leaders Highlight Recommendations for Final Health Care Reform Bill

As the U.S. Congress enters its final push to enact health care reform legislation, state legislators working with Progressive States Network have been raising their voices to make sure key state concerns are addressed in final negotiations.  

On top of the more than 1000 state legislators who have joined PSN's network of legislators urging key reforms, a subset of legislators supported by PSN and working with the White House has been meeting with White House officials and Capitol Hill leaders during the last six months.  Just before the holidays, they shared a white paper produced by the group with D.C. leaders, which details the working group’s concerns, priorities, and recommendations for provisions to be included in the final bill. 

Supporting Federal and State Public Option Efforts:  Among the key priorities highlighted in the white paper, Suggestions for Strengthening Health Care Legislation from State Legislators, is the highly debated creation of a public option. While the prospect for inclusion of a national public option in the final bill appears close to non existent, some opportunity does remain for expansion of the federal employees health program (the OPM provision) to a wider public. But an even more significant step forward would allow federal funds to flow to states that wish to establish a state public option or expand an existing public insurance program.

Bridge Funding During the Implementation Phase: Another critical recommendation made in the paper speaks to the all-important need for states to receive both short-term and long-term funding. Without such funding, it is difficult to conceive how comprehensive health care reform can be successful.

  • Bridge financing during the transition to a new health care system will jump start reform and avoid financial penalties to states that have moved forward to insure low income individuals.
  • The paper recommends policies such as continuing an additional Medicaid match with ARRA or TARP funds, providing temporary funding for state public plans and using high risk pool funds for low income subsidies and early Medicaid expansions.
  • Along those same lines, the paper explicitly calls for maintenance of effort language that will require states to maintain existing levels of eligibility in their Medicaid programs and the need for Medicaid beneficiaries to have access to a “full” benefit package, not a “slimmed down” plan which will result in worse health outcomes.

Strengthening Affordability Provisions: The paper highlights the need for strong affordability measures in the final bill, stating that the Senate bill falls short in helping low income people afford access to health coverage. While support is given to the requirement that individuals purchase insurance, this mandate is only feasible if the subsidies are pegged at a level that recognizes fiscal reality, with exceptions for significant hardships. The recommendation is to adopt most of the cost sharing protections in the House bill, including the subsidy structure and out of pocket caps for people with income below 250% of the federal poverty level and the actuarial values for all populations with incomes below 400% the federal poverty level (FPL). However, the subsidies and out-of-pocket limits for families with incomes at 300% and 400% FPL are stronger in the Senate bill than the House bill and should be retained.

Promoting Real Insurance Options in the Exchanges: With respect to the Insurance Exchange, recommendations include a requirement for a sufficient number of participating insurers and covered lives to present multiple options to individuals and small businesses. The paper calls for retaining the language in the House bill, creating a national Exchange with the option for states to administer a state exchange. In addition, insurance consumer protections and non-discrimination provisions to all insurance plans and providers need to be in place as well as transitional support to states - regardless of whether they have a high risk pool - to provide access to uninsured individuals with pre-existing conditions.

Promoting Cost Containment:  Lastly, the paper addresses a series of acceptable methods for cost containment. These include:

1) payment reform with an emphasis on primary care;
2) incentivizing coordinated care such as medical home models;
3) the use of data to promote evidence-based medicine with strict conflict of interest standards;
4) administrative simplification and electronic record keeping; and,
5) banning prescription drug and medical equipment manufacturers from providing gifts of any kind to providers. 

Over the next few weeks, the Working Group of State Legislators for Health Reform will continue to meet with and communicate their messages with Congressional members and House/Senate leadership. 

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By: Fabiola CarriÓn

Public Transit Best Vehicle for Economic Recovery

An overseen benefit of public transit is the creation and retention of sustainable jobs.  On January 5, 2010, the Center for Neighborhood Technology, Smart Growth America, and U.S. PIRG released What We Learned from the Stimulus, a study that concluded that public transportation generates more jobs than highway construction, although highway construction received more American Recovery and Reinvestment Act funds than public transit. 

Public Transit as a Recession Fighter:  In fact, the data showed that ARRA’s investment in public transportation produced twice as many jobs per dollar as investing in roads.  For every billion dollars spent on public transportation, 16,419 jobs were created whereas only 8,781 jobs were produced for every billion dollars spent on projects for highways infrastructure programs.  Another study conducted by the American Public Transit Association further concluded that 30,000 jobs are created when $1 billion is invested in public transportation.  

It is estimated that the average American household spends 19% of its income in transportation; in contrast, a resident who rides mass transit spends only 9% of his or her income on transportation.  A 4% increase in transit ridership in 2008 demonstrates that public transportation an an alternative to cope during the current economic crisis. Environmental protection is another important motive to switch from private to public transportation. The Urban Land Institute reports that transportation is the largest producer of carbon dioxide emissions in the United States. Numerous studies indicate that energy consumption decreases with transit use: investments in public transportation can reduce greenhouse emissions by 24% by 2050.   

Why Transit Gets the Most Jobs Bang for the Buck:  What We Learned from the Stimulus outlines three primary reasons why public transit investment creates more stable jobs: (1) lesser expenses on land acquisition, (2) the complexities of the projects, and (3) maintenance of public modes of transportation.  Jobs in public transportation are not only comprised of the installation of machinery, but also on their upkeep, dispatch, and operation.  For every transportation-related device that is installed, at least four different job opportunities are created.  Further, transit operations produce 72% more jobs than transit capital investment.  In contrast to road construction, investment in transit transportation creates a stable job market. 

Transit oriented investment is a comprehensive economic solution that serves as a catalyst for further community development.  For example, New Jersey’s Urban Transit Hub Tax Credit Act has attracted businesses and jobs to transit-accessible locations in Newark and Trenton.  Also in Denver, Colorado, the light rail transit system has proven to increase business development near rail stations. 

Critically, public transit development also contributes to the preservation of jobs outside of the transportation sector.  Thanks to a more reliable mode of transportation, more commuters, such as non-drivers, can access jobs they would not be able to get to without public transit.  Further, public transit increases community livability and improves the health of  individuals who cannot go to schools, hospitals, or other needed services by their own means.

The economic benefits from public transit more than repay cost investments. For instance, rail transit services are estimated to provide $19.4 billion in annual congestion cost savings, $8.0 billion in roadway cost savings, $12.1 billion in parking cost savings, $22.6 billion in consumer cost savings, and $5.6 billion in traffic accident cost savings. Rail transit also tends to provide economic development benefits, increasing business activity, and tax revenues.

The Public Supports Public Transit:  Over half of Americans polled said that they would take mass transit if it were more easily accessible from their homes or where they work.   Two in three said the rising price of gasoline makes them more likely to consider using mass transit and 44% would be willing to pay higher taxes if they knew all of the added taxes were being sent on improving or creating public transportation where they live. 

Ultimately, the public recognizes that public transit is not only an investment  for those who work, operate, and maintain the public transit system, but a much needed support for the businesses that surround these areas and for riders who need to commute to their jobs. Given this public support and the disproportionate economic gains, public transit should be receiving more than the one sixth of the federal money apportioned toward highway construction that it currently receives.

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By: Christian Smith-Socaris

Rhode Island Legislature Overrides Governor's Veto of Key Registration Reform

The Rhode Island Senate and House of Representatives voted on Tuesday to override a gubernatorial veto of important electoral reform legislation that will allow voter pre-registration for 16 and 17-year-olds.  Rhode Island now becomes the fifth state, and the fourth in three years, to allow minors to pre-register, a process where their voter registration automatically becomes active upon turning 18. Florida led the recent to move forward with this reform in 2008, with North Carolina and California following in 2009. This reform, while an improvement by itself, is crucially important as part of a greater effort to educate and motivate young people to vote and be politically active.  Commissioned by the Pew Charitable Trusts, a new report by George Mason University professor Michael McDonald found that voter pre-registration in Hawaii and Florida has a direct impact on youth registration and participation when accompanied by civic education initiatives at schools and government agencies.  It also greatly expands the pool of new driver's license applicants who can register at the department of motor vehicles, since most students get at least a driver's permit before turning 18.

FairVote, a non-partisan think tank devoted to improving American elections, has been a leader in the drive to bring this reform to Rhode Island through the efforts of its state affiliate, FairVote Rhode Island.  Working with lead sponsors Rep. Edwin Pacheco and Sen. Rhoda Perry, the legislation (H 5005/S 0085 of 2009) was easily passed by both houses of the Rhode Island legislature four times with bipartisan support, only to inexplicably face Gov. Donald Carcieri’s veto pen each time. This year, after four tries, the legislature moved forward and overrode the governor's veto.  “We are proud to have helped lay the groundwork for today’s important victory,” said Rob Richie, elections expert and FairVote executive director. “With the good will and strong advocacy provided over the years by FairVote and like-minded reformers—such as the leadership of both houses, Rep. Edwin Pacheco and Sen. Rhoda Perry, and Secretary of State A. Ralph Mollis—Rhode Island voters will now have expanded access for its newest voters. This is a good day for democracy in Rhode Island — and the nation.”

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Research Roundup

Workplace Violations in Los Angeles: The Failure of Employment and Labor Law for Low-Wage Workers - Almost 30 percent of low-wage workers in Los Angeles are paid less than the minimum wage and 79.2 percent were not paid the legally required overtime rate by their employers, according to this survey of 1,815 low-income workers conducted by UCLA's Institute for Research on Labor and Employment.  To address these and other pay violations, the report urges greater government enforcement and assure that immigrant workers have full standing in court to come forward to hold employers legally accountable.

How Right Wing Extremists Try to Paralyze Government Through Ideological Smears and Baseless Attacks - This People for the American Way report traces the links between "guilt-by-association" tactics used by Joe McCarthy in the 1950s to current rightwing tactics to smear public officials today ranging from judges like Sonia Sotomayor to progressives nominated for government positions to attacks on President Obama himself.

Supporting Low-Income Students from K-12 through College:

Supporting children and new parents:

  • Roadmap to End Childhood Hunger in America by 2015 - National anti-hunger organizations outline nine steps to eliminate hunger, including immediate steps policymakers can take by funding child nutrition programs and assuring that unemployment insurance covers low-income workers with children losing their jobs.
  • There’s No Place Like Home: Home Visiting Programs Can Support Pregnant Women and New Parents - Home visiting programs, which offer in-home services to pregnant women and new families, can be an effective tool for meeting unmet needs, and they can lead to improved maternal and child health outcomes, positive parenting, safe homes, and connections to integrated assistance, according to this Center for American Progress brief.

New studies on voting rights and reforms around the country:

Please email us leads on good research at


State Leaders Weigh in on Final Health Care Reform Bill

Comparisons of the House and Senate health reform bills - These side by side comparisons are from Politico, the Kaiser Family Foundation and the New York Times.

Working Group of State Legislators for Health Reform - Suggestions for Strengthening Health Care Legislation from State Legislators / Executive Summary

Progressive States Network - Over 1000 Legislators Sign Letters Supporting Federal Health Care Reform

Public Transit Best Vehicle for Economic Recovery

The Center for Neighborhood Technology, Smart Growth America, and U.S. PIRG - What We Learned from the Stimulus

The Urban Land Institute - New Urban Land Institute Publication, Moving Cooler, Underscores Critical Role of Sustainable Land Use in Mitigating Climate Change Research Measures Impact of Various Strategies to Cut Vehicle Carbon Emissions

The Center for State Innovation — Transit Oriented Development

StreetsBlog.Org - Transit Fare Inflation Hitting Health Insurance-Like Levels?

The Apollo Alliance - Public Transportation Investments Can Save Consumers $112 Billion

Zogby International - U.S. Conference of Mayors/Zogby Poll: Most Americans Believe ”˜Going Green’ Will Create Jobs, Improve Communities

Rhode Island Legislature Overrides Governor's Veto of Key Registration Reform

FairVote - Rhode Island Legislature Overrides Electoral Reform Vetoes

FairVote - Youth Pre-registration Factsheet

Michael McDonald - Voter Preregistration Programs

Progressive States Network - Expand Youth Voting


The Stateside Dispatch is written and edited by:

Nathan Newman, Executive Director
Nora Ranney, Legislative Director
Marisol Thomer, Outreach Director
Fabiola Carrión, Broadband & Green Jobs Specialist
Enzo Pastore, Health Care Policy Specialist
Altaf Rahamatulla, Tax & Budget Policy Specialist
Christian Smith-Socaris, Election Reform Policy Specialist
Adam Thompson, Health Care Policy Specialist
Julie Bero, Executive Administrator and Outreach Associate
Mike Maiorini, Online Technology Manager

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