The idea of achieving health coverage for all
may soon become a reality—at least in some states. Building
upon the burst of health coverage initiatives from states like
Massachusetts and Vermont, Congress is beginning to debate two
bipartisan bills (a third is expected) that would partner a
small group of states with federal funding to establish unique
health coverage programs. While the legislation is still in
its very early stages, these bills indicate growing support
for state innovations in healthcare.
The first federal/state partnership bill, “The
Health Partnership Act” (S.2772), was introduced in the Senate
on May 9 by Senators George Voinovich (R-Ohio) and Jeff
Bingaman (D-N.M.) and is designed to provide innovation in
health care through state initiatives that expand access and
improve quality and efficiency in the health care system. Two
months later, a similar bill was introduced in the House of
Representatives by Representatives Tammy Baldwin (D-Wis.), Tom
Price (R-Ga.), John Tierney (D-Mass), and Bob Beauprez
(R-Colo.). This piece of legislation, “The Health Partnership
through Creative Federalism Act” (H.R. 5864), also focuses on
improving coverage and access options in the state and,
although not mentioned in the bill’s purpose, will tackle the
issues of improving quality while trying to decrease costs.
These bills are almost identical in their goals to increase
health coverage and access, ensure that patients receive
high-quality, appropriate care, improve the efficiency of
health spending, and encourage states to test alternative
health reforms.
Although these bills represent a unique
endeavor in federal/state partnerships, each state must apply
to receive funding for program design or expansion. The
funding would be provided through a congressional
appropriation. In addition, there are provisions in the bills
that require budget neutrality prohibiting the state
initiatives from having combined net cost to the federal
government during the five-year grant period.
In both of the bills, states, regional groups,
or local governments (in the absence of state application)
must apply to the State Health Coverage Innovation Commission
with a detailed description of how their program will address
coverage, quality, and cost issues. The proposals should cover
a period of five years with the potential for renewal if the
program has made substantial progress. States could propose a
variety of mechanisms, both public and private, to increase
coverage and must provide specific cost estimates on
public-private financing mechanisms, potential costs to
businesses and individuals and general financial solvency.
After thorough review, the Commission would then select a set
of proposals and submit them to Congress for expedited
(“fast-track”) consideration.
The Commission, which would include members
from the House and Senate, the U.S. Department of Health and
Human Services, state governors and county officials, would
serve as both the evaluative and oversight arm of this
process. Grantee states are required to submit annual progress
reports which will be used by the Commission to evaluate
program effectiveness. A state may also turn to the Commission
for aid in the application process.
Although funding specifics have yet to be
attached to both the Baldwin and Voinovich bills, a third bill
proposed recently by Senator Russ Feingold (D-Wis.) puts a
price tag on potential state grants. According to the
Milwaukee Journal Sentinel, Feingold is proposing to
set aside $32 billion in funding for a few selected states to
design universal health care plans. While the specifics have
yet to be fleshed out, Feingold mentions that two or three
states could participate in the plan or states could apply in
groups for funding. Like the Baldwin-Price and
Voinovich-Bingaman bills, application to an oversight
commission would be required and the grant would be for five
years with the potential for renewal. Under the Feingold
legislation, states would have to contribute 25 percent in
matching funds to the program with the federal government
paying the remaining 75 percent of the cost. His proposal
includes funding the federal portion by increasing airline
passenger security fees, increasing the rebate drug
manufacturers pay to Medicaid, and extending the fees for
customs and borders by two years. As of publication date, the
bill has yet to be introduced.
For more information on current state
innovations in health coverage, visit our website at www.statecoverage.net.
