Looking Forward

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As we enter one of the most challenging economic times our country has faced in recent memory, it gives us pause to consider that a new window of opportunity may be opening with respect to health reform. Despite all the bad economic news and worsening forecasts for the coming year, there is a tinge of optimism that comes with one of the most popular words this year—change.

Will there be national health reform under the Obama administration? The answer varies depending on who you ask. Many think that the economic crisis and its widespread impact—especially the on health care system, the uninsured and state budgets – make the case for, not against, reform. They believe a crisis warrants action. 
While many hoped the passage of comprehensive reforms would continue to define state health reform in 2008, the year brought more struggles than successes. The recession has already caused profound dismay in state capitols around the country and we predict that 2009 is likely to bring further retrenchment. States have weathered tough economies in the past, and they will build upon those lessons to mitigate the impact on their most vulnerable populations. Yet difficult decisions will have to be made. In some circumstances, states are likely to consider and implement cuts to public health care programs. 
During the next few years, the health reform debate will place an enormous spotlight on the issues surrounding health coverage and systems reform. It is our hope that this important discussion will also include the role of states and their potential contributions to national reform. While federal action could range from a stalemate to sweeping changes, it is unclear how these changes would impact individual states. Regardless, states are likely to continue to play a critical role in meeting the nation’s health care needs.
In the meantime, states find themselves in a precarious position: should they wait for a federal solution to their health care problems or continue to forge policy innovations within the domains over which they have control? Several states have been working for years on a policy-development process and a sequential approach to health reform. It is unclear whether economic pressures will force these states to halt their processes mid-stream or whether health care leaders will continue to push for reform and/or support those efforts.
The challenges are enormous, and history tells us that health care coverage expansions—and overall health reform—are difficult to enact and sustain. Yet it is possible that the size of the problem and the focus of the American people on the issue will lead to positive changes, at either or both the federal or state level. 
The cost of inaction continues to mount, both in lives lost and costs to the system. It is our hope that 2009 will the be year the country turns its attention to health care and finds real, workable solutions to the problems of access, cost, and quality. We hope this can be accomplished through a partnership between states and the federal government that will enable each to use their respective strengths to improve the health and health care of all Americans.