Commentary: Health care law that needs to be addressed

The State (Columbia, S.C.)February 9, 2011 

With Gov. Nikki Haley lobbying for the right to create a special, as-yet-undefined S.C. program to replace the federal health-reform law, I thought it would be educational to sit in on an expert discussion of “ways in which some states are pursuing waivers in order to create their own alternative programs for delivering health care.”

It was educational, all right. But not in the way I expected.

There was precious little talk about all those innovative ideas the states are hatching to get more people insured at a more reasonable cost, with insurance that doesn’t evaporate when it’s needed most. In fact, about the only state initiatives that the panelists at Governing magazine’s Outlook in the States & Localities conference last week in Washington discussed were those in Massachusetts — which was the model for the federal law — and Utah, which has taken an approach that the National Conference of State Legislatures’ Joy Johnson Wilson insisted has much more in common with Massachusetts’ program than most reports suggest.

There are two reasons for the paucity of reform models: The goals of the federal law require complex statutory, regulatory and behavioral changes and will not be met by a simple initiative; and the states, uncertain about the legal and political climate, are having too much trouble figuring out how to pay for Medicaid next year — much less two years down the road, when the health law requires them to expand Medicaid coverage — to even think about leading the nation forward with alternatives.

“Independent of the health-care act, there are a lot of people concerned that A plus B is not going to equal C,” the National Governors Association’s Matt Salo said. With the states facing a cumulative budget shortfall of $175 billion next year, he said: “There will be cuts to Medicaid, but you can’t get $175 billion in cuts to Medicaid.… What you may see is states eliminating higher education funding, or gutting K-12.”

“This is why everyone should care about Medicaid,” Ms. Wilson added. “If you have kids in K-12, higher ed, you’re gonna feel it. Criminal justice, roads and bridges. That’s what people don’t get: States are not going to be able to finance the expansion (of Medicaid) with state funding.”

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