State Legislator to Aid in Implementation of HC Reform

Note:  I was recently appointed to the executive committee of this group of legislators,along with Rep. Sharon Treat, of Maine, and Sen. Karen Keiser, of Washington. For more information call Sen. Dede Feldman 505-220-5958.

Daily News

White House Gives State Lawmakers Nod To Help Shape Reforms

Posted: May 12, 2010

Following a nod from the White House two weeks ago, state legislators are setting up a nationwide-group that is expected to play a key role in the federal government's implementation of the new health reform law, particularly when it comes to policies affecting states. By forming the group, state lawmakers who informally helped shape the federal law will now be ensured a seat at the table as HHS writes implementing regulations, sources say.

The Working Group of State Legislators for Health Care Reform had already existed as a loosely formed informal group of state lawmakers – a group the White House had encouraged to form about a year ago in support of health reform, said Iowa Democratic state representative Jack Hatch. The group has always been self-directed, despite being formed at the administration's urging, and now has White House support to expand and take on a more formalized role.

White House officials were pleased that state lawmakers wanted to play a role in the reform law's implementation, Hatch said, so they gave the go-ahead to the group. The group will form an executive committee and within a month the group is expected to come up with a handful of policy areas on which it will work with HHS and others. Representatives of the group will meet quarterly in Washington with Congress, the White House, HHS and others involved in implementation. They already have been participating on weekly phone calls that include insurance commissioners, Medicaid directors, and HHS officials.

At present, the group has nearly 90 representatives from 32 states, and plans to expand its membership to all 50 states within two to three weeks, Hatch said. Members are state legislators in key positions, such as chairs of committees with jurisdiction over finance, health or insurance policy.

As a second mission, the group is creating a peer-to-peer education program that will allow states to borrow successful approaches from one another. Five to six focus areas will be identified, Hatch said, and will likely include high-risk pools and exchanges.

One of the first areas the group is likely to tackle are the short-term high-risk pools the law mandates for residents who cannot find affordable insurance. Sharon Treat, a Maine Democratic state representative who also is director of the National Legislative Association on Prescription Drug Prices, said this is a good example of the kind of issue the new group will deal with.

She pointed to ambiguities in the reform law's mandate in this area. For example, she noted that the Maine legislature created a public-private Dirigo Health Agency in 2003 to provide health insurance for people with pre-existing conditions who could not otherwise find affordable health insurance. It's not a high-risk pool, but it serves much the same purpose, Treat said, and it's not clear whether it fulfills the high-risk pool requirement under the new health law.

HHS gave states several options for high-risk pools, including establishing a new pool to supplement any special insurance programs they already maintain for high-risk residents.

A less-formalized version of the state legislators' group played a role during the congressional debate. It offered political support for health reforms and became involved in helping shape the legislation that ultimately became law, Hatch said. For instance, the group pushed for cost containment, which eventually led U.S. congressional staff to come up with the Independent Payment Advisory Board. The group also was instrumental in getting the reform law to limit the cost of insurance plans offered in the state exchanges to 9 percent of family income. The state lawmakers also advised the U.S. Congress on the level of funding that states would need and encouraged measures requiring minimum standards for plans in the exchanges. (Not all efforts were successful. The group pushed hard for a public option.)

Once the reform legislation was signed into law, Hatch and others decided to approach the White House about formalizing the group so states could influence the law's implementation.

U.S. Congress left it to states to reform much of the health care system. States must set up the insurance exchanges, oversee Medicaid's expansion, integrate Medicaid with the exchanges, apply new income eligibility standards and enforce the new insurance regulations.  States will vary in how they handle implementation, a House Ways and Means staffer said. States that already were operating managed care programs will likely fare the best because they will be able to absorb at least some of the new Medicaid recipient with contractors that run the managed care projects. --John Wilkerson