During their recesss, members of Congress are got an earful of what Americans and special-interest groups think of a “public plan” in health care reform, and confusion and political panic seem to be reigning.
But what about the states?
We believe that states should continue to address their own unique health care challenges, in partnership with the federal government.
States have been exploring innovative ideas for years in implementing health care reform. The most visible example recently is Massachusetts. Other states have also shown great initiative and innovation, in partnerships with the federal government, building on established safety-net programs. States are better able to maximize local resources and achieve the necessary partnerships with non-profit and for-profit providers. States have been successful as incubators of reform on a wide range of issues.
Our Colorado mountains are majestic, but solving the problems that our geography and demographics impose on provider networks requires creativity. Thus, the reforms that have emerged in Colorado are local, more regional plans, maximizing the limited resources available.
Such unique and successful programs developed in Northern Colorado and on our Western Slope have been cited in recent weeks as models of reform. A recent Colorado health care reform study examined Colorado’s needs, what the legislature might consider, and the costs. We have worked for implementing small group health insurance changes where we could. We have reformed the delivery of public health services where we could, as well as working to expand the use of technology in delivering health care services where appropriate. And we are making progress on a better health care system for Colorado’s children, pregnant women, and low-income adults. However, the economy is now challenging the future of the progress we have made here and in most states.
When the nation’s welfare system needed a major overhaul because of ever-increasing costs, President Clinton and Congress gave it to the states to resolve, recognizing that states’ welfare populations varied.
The president and Congress might look to the states for a compromise in the debate over an alternative to a “public plan.”
From our perspective, the debates have seemingly ignored existing state-administered “public plans.” Currently, each state provides services to some portion of its citizens through state-administered Medicaid programs. Why has there been no consideration given to allowing states to address their unique needs and populations within a national framework?
Many Americans have been expressing satisfaction with their coverage plans, especially in hard-to-serve areas and regions. The programs and networks in these areas are also touted as models of reform. The states are able to build on what has been successful within their borders, by expanding their own safety net programs and/or expanding local and regional networks through their own partnerships.
Our proposal is an alternative to a national “public plan” — it is the idea of a partnership between the federal government and the states.
Like the “welfare-to-work” program, Congress would provide the financial resources to the states based on states’ specific populations and resource needs, while keeping current safety net programs with enhanced sustainability, and without shifting unfunded burdens to the states in the process. In addition, Congress should impose a minimum number of federal standards, such as those necessary for portability, subsidized buy-in, and open access to coverage for all.
States have worked to resolve health care access, affordability, and quality-of-care issues. In the process, state legislators — and governors — have become experienced in working with the various special interest groups, including many of the ones bottlenecking Washington right now.
We urge members of Congress and their constituents to seriously consider the idea of allowing the states to custom-design their own plans to cover their respective uninsured populations.
Anne McGihon and Bob Hagedorn are former Colorado state representatives.
