In State-of-the-State Speeches, Governors Present Healthcare Priorities

As President Obama puts his final touches the State of the Union speech, governors across the country are wrapping up their own annual assessments. This is State of the State speech season.

Across the country, governors are opening legislative sessions with a look back at their accomplishments and a look forward to their goals for the upcoming year. We've rounded up several and taken a look at how healthcare has fared in these speeches. It's definitely a mixed bag.

There's a lot of worry about Medicaid expenses and negative talk about healthcare reform. But there's also plenty of insight into state priorities such as eliminating pill mills, increasing rural access to healthcare professionals, introducing care coordination to Medicaid and the development of health insurance exchanges.

Here, in alphabetical order, are excerpts from some of the speeches that governors have delivered so far:

Gov. Jan Brewer (R-Arizona)
"Arizonans and Americans are saying to Washington, D.C.: We don't like an ever-expanding government threatening our personal liberties. We don't like government living beyond its means and trying to be everything to everyone. We don't like unconstitutional—and unfunded—healthcare mandates."

Gov. John Hickenlooper (D-Colorado)
"We are well on our way to establishing a Colorado Health Benefits Exchange. We are doing it Colorado's way and it will be ready at the end of 2013 to support small businesses and provide health insurance for 300,000 Coloradans who presently do not have it.

"We are committed to bending the Medicaid cost curve and pursuing strategies that will cut Medicaid costs. We are tackling fraud, over-payments and eligibility. We want to move away from the expensive fee-for-service system to one that drives toward value and rewards healthier outcomes. We have already started to make progress by focusing on preventive care, reducing obesity rates and improving the technology that links people to services. These efforts will all result in important cost savings."

Gov. Jack Markell (D-Delaware)
"The incentives we have in place in our healthcare system reward neither efficiency nor quality. These incentives encourage more services and tests, not better results. We have a system that doesn't encourage healthy behavior in patients and doesn't discourage unhealthy behavior. In essence, we don't have a healthcare system; we have a sick care system.

"Delaware's biggest purchaser of healthcare, the state (government), needs to insist on incentives for providers that are aligned to improve quality and discourage waste. Our Medicaid population, and our state employees and retirees represent nearly 40% percent of the health insurance market here, accounting for a total of $1.7 billion of taxpayer expenditures. We look forward to working with the provider community to get these incentives right because the incentives at work today are the wrong ones. We are pleased that the Delaware Medical Society and Delaware Healthcare Association are already active on this issue and have agreed to work with us."

Gov. Nathan Deal's (R-Georgia)
"Georgians deserve a world-class, public medical university, and it will be a priority of this administration to have a medical college among the top 50 nationally. The Georgia Health Sciences University will seek to become the state's second National Cancer Institute designated Cancer Center. This designation would mean greater access to research dollars and enhance our ability to recruit top cancer specialists. To support this goal, my budget proposal includes an investment of $5 million.

"To address the need for additional health professionals in Georgia, we have been investing in the expansion of undergraduate medical education for several years. We must now take the next step in this process by increasing the number of graduate residency slots. My budget funds 400 new residency slots in hospitals across the state. We must ensure that no doctor trained in Georgia is forced to leave the state to complete his or her medical education."

Gov. C. L. "Butch" Otter (R-Idaho)
"The Obama administration's so-called Patient Protection and Affordable Care Act mandated establishment of a health insurance exchange in each state. I have struggled with the federal imposition of this mandate, in part because Idaho was exploring ways to create its own market-based health insurance exchange long before the federal law was adopted.

Still, last September I allowed State agencies to apply for a grant to prepare for the federal law while we continue fighting it in court. My decision to allow the application to be submitted simply preserved the opportunity for you and all Idahoans to discuss our options and decide what's best for our citizens.

"In the next few weeks we will continue to have those discussions—weighing all our options and the potential outcomes associated with each of them. It's important to remember that those discussions will be taking place in the context of the U.S. Supreme Court agreeing to consider the lawsuit that Idaho and 25 other states filed to protect the 10th Amendment rights of Idaho, and of the people, to choose."

Gov. Sam Brownback (R-Kansas)
"Medicaid spending continues to skyrocket, and it continues to place stress on funding for education, public safety, and other essential services. With additional funding cuts expected from the federal government, Kansas must transform Medicaid into a system that improves services while managing costs. Many states have made the choice to either kick people off Medicaid or pay doctors less. Neither of those choices provides better outcomes. Kansas has a better solution. (We) have produced a measured, innovative and compassionate proposal. Unlike the current one-size-fits-all system, we will offer all Kansans a choice of plans that best fit their needs.

"For years Medicaid was spread among several cabinet agencies. This year we will continue to make government smaller and better focused by consolidating multiple agencies into a restructured Department of Aging and Disability Services. By running government more efficiently and effectively, we can save money and provide better service."

Gov. Steven L. Beshear (D-Kentucky)
"A recent report from the Kentucky Department for Public Health showed that more Kentuckians die from prescription drug overdoses than from car accidents. Think about that: Our medicine cabinets are deadlier than our highways. My friends, this is a scourge. We have to stop it.

"In the last year, we persuaded Florida to begin shutting down its pill pipeline into Kentucky. We created an interstate task force with officials from Ohio, Tennessee and West Virginia to
better identify those who exploit our borders in order to abuse, misuse or divert prescription
drugs.

And we've also strengthened our ability to identify irregular and improper prescribing habits through Kentucky's electronic monitoring system, called KASPER. But KASPER isn't as effective as it could be. During this session, you will be asked to consider a wide-ranging package of legislation designed to strengthen KASPER, including making participation mandatory, and cracking down on pill pushers in white coats and on pill mills in Kentucky."

Gov. Dave Heineman (R-Nebraska)
"Our state has been working hard for nearly two years to protect Nebraska's interests, and I want to assure you and our citizens that Nebraska will not default to the federal government regarding a health insurance exchange. However, it is important to recognize that the U.S. Supreme Court will decide whether this law is constitutional or not by June 29 of this year. The simple truth is it would be a costly mistake to spend millions of taxpayer dollars to begin implementing Obamacare until the U.S. Supreme Court makes its decision."

Gov. Susana Martinez (R-New Mexico)
"As we continue to do more with less, we must never forget that our budget is a statement about our values. That's why my budget invests $45 million more in Medicaid, providing healthcare for the poor and the disabled."

Gov. Andrew Cuomo (D-New York)
"Almost 16 percent of New Yorkers under the age of 65—2.7 million people—are uninsured. Most are working people and their dependents. We have a unique opportunity to address this challenge by developing a New York State Health Insurance Exchange that will be financed entirely by the federal government.

When the Exchange is implemented, more than one million New Yorkers will gain health coverage and individuals who currently buy their coverage directly will see their cost drop by 66%. Small businesses will see the cost of providing coverage to their employees drop by 22%. In addition to the benefits to the uninsured and small businesses, the Exchange will benefit New York's taxpayers. The $1.7 billion that taxpayers currently contribute to offset the cost of providing care to the uninsured will be significantly reduced. The increased federal Medicaid match that recognizes New York's higher Medicaid eligibility levels will bring an additional $18 billion in funds to the state over 10 years."

Gov. John Kitzhaber (D-Oregon)
"All of our job creation and economic development strategies will be futile in the long run unless we are successful in transforming…our healthcare system. We can no longer simply stand by while businesses, families, and your state government are forced to spend more and more every year on an inefficient, hyper-inflationary system that is not making us healthier as a population—dollars that otherwise businesses could be using to create new jobs; families could be using to get out of debt and pay off their mortgages; and the state could be using to invest in children and education.

"In last year's legislative session we set the state stage for fundamental changes to our health care system. We created the state's first health insurance exchange to provide individuals and small businesses with easy to compare information on the quality and price of various health plans. We committed to transforming the delivery of healthcare to reduce year-over-year cost increases while improving health outcomes for Oregonians."

"The business plan for our new Coordinated Care Organization shifts the focus and financial incentives from the emergency room and after-the-fact acute care to prevention, early intervention, and community-based management of chronic conditions. The potential cost savings for the state are substantial – more than $3 billion in the next five years."

Gov. Nikki Haley (R-South Carolina)
"We are tackling the root causes of our problems, not just the symptoms. Healthcare providers are now working in partnership with us to improve quality and lower costs. We identified payment reform to align incentives between healthcare providers, payers, and patients as a top priority and are implementing strategies to do just that."

"We are shifting towards Medicaid managed care, which independent studies show saves us money and delivers better quality than traditional Medicaid. And for the first time, we are giving managed care companies a financial stake in improving quality year after year. No longer will the State of South Carolina bear the costs of poorly managed healthcare alone. We will continue to push back against the federal takeover of our healthcare system. South Carolina does not want, and cannot afford, the President's healthcare plan. Not now and not ever."

Gov. Dennis Daugaard (R-South Dakota)
"I formed the Medicaid Solutions Workgroup during the last legislative session to see what we could do to control the growth of Medicaid spending. What they found was that South Dakota's Medicaid program is an efficient and conservative program. We have never had many of the expensive options that now burden other states, and there are not many things to cut."