More than two dozen states have launched healthcare reform initiatives, but most are strapped financially and are unlikely to undertake major reform while federal legislation is stalled on Capitol Hill, says a top health official for the National Conference of State Legislatures.
"A majority of states are clearly going to wait and see what the federal government is going to do," says Richard Cauchi, health program director for the NCSL.
That doesn't mean the states have been inactive, Cauchi adds. At least 26 states are considering healthcare regulations ranging from management of chronic disease to healthcare quality improvements, as well as insurance programs for children, he says.
Other programs considered are special grants for needy individuals, a special insurance program for state employees, Medicaid expansion and Medicaid buy-in plans, and changing to a single-payer system.
"States are very active in health changes and innovation in one sense–that there is legislation being considered to do all manner of things with health reform, but it's not comprehensive or universal," he says. Comprehensive reform entails achieving near universal coverage of state residents.
Missouri is one state that is considering comprehensive coverage. State lawmakers in January introduced comprehensive legislation that would establish the Missouri Universal Health Insurance Act to provide "comprehensive and necessary healthcare services" for Missouri residents.
Legislation would provide comprehensive health, mental health, and dental care for residents, according to the state legislation. In Maryland, a bill was introduced that would require the health system to provide healthcare services "to all residents of the state under a single system that is not dependent on employment."
However, states are also facing time and fiscal barriers. Budget constraints and limited days in which state lawmakers are in legislative session have contributed to the lack of widespread action, he says.
"The recession has made it harder for states to finance programs to cover the uninsured," the states' organization said.
In November 2009, states closed a cumulative budget gap of $145.9 billion with new gaps reported and predicted to continue through 2012. For some states, however, there is a feeling "why should we wait and they are not shy about trying something," according to Cauchi.
Within the past week, Cauchi says Colorado officials announced a major package to strengthen the state's healthcare system. State officials said they were focusing on cost-savings, improvements to public and private insurance programs, and better care for women.
"The demands on our healthcare system and the costs of providing care continue to increase for Colorado families, businesses, and providers, " said Gov. Bill Ritter Jr. in a speech before the Colorado Health Foundation on Feb. 11. "We can't wait for Washington to act and we aren't."
States, such as Colorado, may be moving ahead with some healthcare reform, but most are still far from Massachusetts, which has an individual mandate. Maine and Vermont are the exceptions. They have their own versions of comprehensive health reform, Cauchi said.
Other states have adopted expanded—though not comprehensive—healthcare reform, such as Connecticut, Florida, Illinois, Iowa, Minnesota, New Jersey, Utah, and Washington. Some states have enacted healthcare changes, such as insurance exchanges, pre-existing condition legislation, and other actions now considered in the federal reform bills.
States that have legislation introduced for some aspect of healthcare reform or build on what they already have, include: Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa, Kentucky, Maryland, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, Oklahoma, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wyoming.
About 46 million Americans lacked health insurance in 2008, as the number of uninsured increased during the recession as people lost jobs and employer-sponsored health insurance. At least 10 states have passed laws to achieve universal coverage for children, and "others are working toward that goal with many more states incrementally expanding eligibility for children in Medicaid/SCHIP (State Children's Health Insurance Program) in the past three years, according to Cauchi.
While the states contemplate their own healthcare plans, there has been much debate about whether the state approach to healthcare reform should take the lead in health reform.
Henry J. Aaron, a senior fellow for economic studies at the Brookings Institution, says he once supported state reforms, but he now favors a national approach to revamp the healthcare system, in part, because of the states' fiscal problems.
"There is not yet disposition in the states to do anything that would entail a financial commitment" to make significant healthcare changes, Aaron says. "They are still fiscally flattened by the recession. Even if Congress acted, the states could do nothing that would entail any financial commitment."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
