Legislation increasing states' role in health reform

TIME reports that states "could have a surprising degree of autonomy in determining how they implement" federal health reforms. "Though most everyone recognizes that the federal government can't impose a rigid approach, some critics say that the crucial version of legislation expected to pass Senator Max Baucus' Finance Committee in the next week ... may go too far in the other direction."

"While governors are primarily focused now on how their already hurting state budgets could be strained by the expansion of the Medicaid program proposed in all the health bills, there are other key responsibilities that could fall to them under the Baucus bill." For instance, the bill's so-called insurance exchanges, the "Web-accessible marketplaces where individuals and small groups would compare and shop for private insurance," would be established at the state level. "By contrast, the House bill would create one national Exchange. ... Just last week, during markup of the bill, at least two amendments were tacked on to the legislation giving states further latitude" (Pickert, 10/7).

The Wall Street Journal/Dow Jones reports: "U.S. Senate moderates on Tuesday praised a proposal to allow states to establish public health-insurance plans as part of health-care legislation, giving it a boost as a possible alternative to a public plan run by the federal government." Sen. Thomas Carper, D-Del., first proposed the state-based approach: "The proposal, which is currently in draft form, got a boost Tuesday when two moderate Democrats in the Senate - Sens. Ben Nelson, D-Neb., and Kent Conrad, D-N.D. - praised it as a possible way to reach consensus. Nelson is one of several moderates who has expressed discomfort with a public plan run by the federal government. ... Because Carper's proposal isn't included in bills that have been considered by two Senate committees, it would have to be added to the legislation as an amendment on the Senate floor. A Carper spokesperson said it is 'unknown at this point' whether it will be offered as an amendment to the bill" (Yoest, 10/6).

In a separate article, the Wall Street Journal reports on increasing support for the plans: "Some influential centrist Democrats in the Senate are warming to a compromise that envisions health-insurance plans run by state governments" (Hitt and Adamy, 10/7).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.