There are stark differences between the two presidential campaigns'
approaches to federal-state relationships. Differences range from the
amount of funding appropriated for programs run by the states to
whether the candidates would strengthen or weaken state regulatory
Bringing Medicaid and SCHIP to more people is one of the best and most
cost-effective ways to broaden access to health care coverage.
Medicaid and SCHIP bring in valuable federal dollars and frequently do not
require new administrative structures.
In fact, maintaining or broadening investments in social services can
up an ailing economy. Additionally,
states can use their bargaining power achieved from a robust Medicaid program
to negotiate better deals on health care services, like prescription drugs and
durable medical equipment, and to create incentives for better quality care.
Politics, particularly in small states, makes for strange bedfellows.
The latest effort to derail Maine's first-in-the-nation 2003 Dirigo
Health Reform initiative bears this out. The president of the State Chamber of Commerce and a former member of the Dirigo Health Board of Directors is now treasurer of a lobbyist-driven political action committee waging a campaign to sap Dirigo Health of its funding.
One year after implementation, Massachusetts new health care law has
dramatically reduced its rate of the uninsured by half, increasing
coverage in both the public and private sectors for 355,000 previously
uninsured residents, a new Urban Institute study published in Health Affairs shows. The state has improved access to coverage but rising costs are a key challenge as the state moves forward.
Incremental steps to improve the health care system can lay the
foundation for comprehensive reform that provides health care for all.
Comprehensive reforms enacted in Massachusetts, Vermont, Maine and San Francisco were, in large part, the result of pragmatic incremental steps those states had already taken. For example, a Families USA report discusses the many reforms Massachusetts put in place over the years that led to its comprehensive 2006 reform. Not every state is as far along in moving comprehensive health care reform, but
each state does have numerous options for increasing access to
coverage, reducing the growth of health care costs, and improving the
quality of care.
As Congress debates a stimulus to the economy in the wake of the
housing bust, many economists are urging federal leaders to make aid to
state governments a core part of the package. While direct tax rebates
for individuals can help, it will not do much for the economy if states
are forced to cut back on critical spending on public works, health
care, and education at the same time. As Nobel prize-winning economist
Joseph Stiglitz, who was also chair of the President's Council of
Economic Advisors in the 1990s, wrote this week in the New York Times:
It's now ten years since the 1996 welfare law promised to end "welfare
as we know it." That goal may have been accomplished, but the results
have been decidedly mixed, both for poor families and for state
lawmakers coping with changing federal mandates.