States that sit on the sidelines waiting for the results of the November election before they commit to healthcare reform and health insurance exchanges will face a "herculean effort" to establish their exchanges and implement reform says Anthony Brown, the Maryland lieutenant governor. "We've been at it for 18 months in Maryland."
Brown pointed to consensus building with legislators about the role of healthcare reform and health insurance exchanges. "We worked with them over three separate annual legislative sessions. Legislators weren't under the gun. They had time to carefully consider and revisit issues."
Brown says Maryland has used the time to successfully compete for federal dollars available to fund the exchanges and other components of healthcare reform. No matter what political or legal outcomes are presented, Brown said, "we are committed to implementing as much of the Affordable Care Act as we can."
The lieutenant governor spoke during a daylong briefing on the Affordable Care Act hosted by Health Affairs.
He asked for a show of hands from attendees representing states where there is public/political/legal opposition to the ACA. Then he asked that group if they had noticed executive departments working clandestinely with private sector and nonprofit participants to lay the foundation for the eventual implementation for the ACA. The show of hands confirmed, he says, that even in states where the ACA is opposed, progress is being made to implement healthcare reform.
Maryland was among the early adopters of provisions of the Patient Protection and Affordable Care Act. Brown says that on the day President Obama signed PPACA into law, the governor of Maryland established the Healthcare Reform Coordinating Council to help implement the PPACA. "I can say that there was a significant amount of anxiety among stakeholders who wondered what the Affordable Care Act meant for them."
Brown notes that while some states have voiced concerns about the exponential increase in healthcare costs that may come as part of healthcare reform, Maryland officials are convinced that the state has more to gain than lose.
An early study by the University of Maryland indicated that implementing the ACA would help the state save $700 million in its budget and reduce the number of uninsured by 50%. A follow up report released last week confirms the savings and estimates that the ACA will generate more than $3 billion in economic activity for the state, an create 26,000 healthcare jobs by 2020.
Brown says Maryland has elected to create its own health insurance exchange because the state has no interest in being part of the default federal exchange. "We believe our exchange must be designed to address Maryland's specific healthcare needs."
He challenged states to take the lead on their own exchanges. "Each state is unique and this is an opportunity to tailor your exchange to meet the specific needs of your state residents."
Brown credits the Maryland legislature with being a key supporter of the effort. "The real action and success of the ACA will happen in state capitals around the country." Because the ACA doesn't guarantee healthcare cost control, one big step is for states to "affirm or strengthen their commitment to implement serious and sustained efforts to bend the cost curve."
For Maryland, that has entailed the development of state and local health improvement plans to identify priorities and set measurable targets, the creation of a model for patient-centered medical homes, and increased adoption of health information technology.
Brown acknowledges that states are right to worry that federal funding, especially for Medicaid expansion, is committed only until 2020. He refers to 2021 as "hitting the cliff" but says that's why bending the cost curve is so important.
He says time is of the essence and states should "use this time to develop programs that benefit their residents."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
