This week, the Washington State Senate's health committee approved a
bill to achieve health-care-for-all by 2012. Sponsored by committee
Chair Sen. Karen Keiser, SB 5945 as amended
combines immediate steps to expand access to coverage and cut
administrative costs with a planning process to refine proposals for
comprehensive reform by 2012. This action came as the Seattle City Council and Seattle Post-Intelligencerendorsed national single-payer health care, emphasizing the continuing efforts in states to move forward health care reform.
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
Creating new incentives for quality care and improving the
management of diseases are key policy goals towards reducing the growth of
health care costs and making sure Americans get the right care at the right
time. Efforts include managing chronic disease, paying for performance, ending reimbursement for avoidable hospital errors, reducing hospital-based infections, electronic medical records, and promoting best practices.
As states face another economic downturn and growing budget deficits,
expanding access to coverage may seem like an impossible goal.
However, there are steps states can take to generate revenue and
"stretch" health care dollars to ensure access to health care. These include using existing tobacco-settlement dollars dolely for health care, instituting employer pay-or-play requirements, improving prescription drug purchasing, improving chronic care management, and ending corporate tax loopholes.
The great majority of employers want to provide health care benefits to
employees and their families. Despite a
steady decline in the percentage of Americans with employer-based coverage,
from 66% of Americans under age 65 in 2000 to 61% in 2004, employers
still cover more than 158
million Americans, more than twice the number of Americans who receive
Medicaid or Medicare. Because of the
financial contributions employers make to health
care, ensuring strong employer participation in health care reform is
a key priority.
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.
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.