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April 2010 St@teside

States Take Different Approaches to Respond to Federal Health Reform

With the passage of federal health reform, pressure has quickly mounted on states to develop action plans to implement the reform legislation. Though a number of options lie before states, many governors have begun to create advisory councils via executive order to ensure full compliance with the federal law and the infusion of funding it brings. States that have created these advisory council structures include:

  • Connecticut: In anticipation of the passage of federal health reform, Governor Jodi Rell issued Executive Order 30 last July, creating the Connecticut Health Care Reform Advisory Board. The 15-member board is headed by Deputy Commissioner of Public Health Christine Vogel.  The board will make proposed health care policies in response to federal legislation, focusing on cost containment, maximizing federal matching funds, designing best practices to enhance access to preventive care, and assuring health care coverage for all children entering the primary and secondary school system. The executive order stipulates that the board make a preliminary report on Feb. 1, 2010, and give its final report to the governor and General Assembly by Jan. 1, 2011.  Following its final report, the board will be terminated.

  • Colorado: In an Executive Order signed on April 20, 2010, Colorado Governor Bill Ritter named a director of health reform implementation in Colorado and also created the Interagency Health Reform Implementing Board. The executive order named Lorez Meinhold, the governor’s health policy advisor, as director of implementation, and the board will be headed by Joan Henneberry, executive director of the Colorado Department of Health Care Policy and Financing. The board will develop a strategic action plan, coordinate implementation efforts among federal, state, and stakeholder agencies, provide transparent information to Colorado citizens on the various components and effects of the federal health reform legislation, and recommend executive and legislative action to successfully implement the federal legislation. Additionally, Governor Ritter signed four bills into law designed to improve transparency for health insurance consumers and improve Colorado’s health care workforce.

  • Maryland: In an Executive Order signed on March 24, 2010, Maryland Governor Martin O’Malley ordered the creation of the Maryland Health Care Reform Coordinating Council. The members of this council will include the secretary of health and mental hygiene, the secretary of the Department of Budget and Management, and the insurance commissioner, among others. The council will submit a comprehensive review of the federal health care legislation to the governor by July 15, 2010.  This review will include an implementation timeline, estimates of the reform on the state budget, and recommendations on developing and evaluating policy options for the state, including methods of soliciting input from interested stakeholders. Using this review as a basis, the council will then submit a final report with policy recommendations and implementation strategies by Jan. 1, 2011.

  • Michigan: On March 31, 2010, Michigan Governor Jennifer Granholm issued an Executive Order creating the Health Insurance Reform Coordinating Council.  The eight-member council will be headed by the director of the Department of Community Health, along with other state department directors and the state budget director. The council will conduct a thorough review of the federal health reform legislation, develop a coordinated response to implementation of the reforms, and a create a process to engage local stakeholders. Additionally, the Executive Order also creates the Office of Health Insurance Consumer Assistance within the Office of Financial and Insurance Regulation. The insurance commissioner is designated as an insurance ombudsman, whose office will help provide consumers with health insurance information, file health insurance complaints, and ensure compliance with federal laws and regulations regarding health insurance.

  • Washington: On April 1, 2010, Governor Chris Gregoire issued an Executive Order creating the Washington Health Care Cabinet. The cabinet will write and implement rules and regulations to carry out the federal bill’s reforms for all state agencies. The cabinet will submit a detailed work plan to the governor no later than Aug. 1, 2010, and will be required to report to the governor monthly from April 2010 to March 2011, and will report quarterly thereafter. Governor Gregoire also announced a plan to consolidate state purchasing of health care services, starting with combining the purchasing of the state’s Medicaid program and the Washington Health Care Authority. The Health Care Authority, led by current State Medicaid Director Doug Porter, will oversee the governor’s proposed changes. Porter, and other state department leaders, will also serve on the Health Care Cabinet.

  • Wisconsin: On April 7, 2010, Governor Jim Doyle issued Executive Order 312 creating the Wisconsin Office of Health Care Reform. The office will be co-led by the secretary of health services and the commissioner of insurance. Governor Doyle tasked the newly created office with providing transparent access to health insurance information, assessing insurance market reforms needed to prepare Wisconsin for the implementation of reform in 2014, developing a plan to pursue federal funds for a high-risk pool, and creating a state health insurance exchange.  The office also has a website to provide Wisconsin residents with information about reform, the phases of implementation, and how the reforms may benefit citizens.

Other states have sought to delay or prevent the implementation of federal reform via legislative action. In Georgia, S.B. 399, passed out of the Senate on March 26, would forbid any state agency from implementing components of the federal health reform legislation without first receiving permission from the General Assembly. Similarly, in Utah, Governor Gary Herbert signed H.B. 67, which requires the Utah Department of Health to analyze federal health reform requirements before implementing them and determine the degree to which federal reform will affect Utah’s existing reform efforts. Additionally, many states have introduced laws and constitutional amendments which aim to prevent implementation of various components of the federal reform (most often the individual mandate). To date, only Idaho and Virginia have successfully passed such laws.

Eighteen states have filed suit against the federal government, seeking to have the reform legislation declared unconstitutional. The lawsuit was given an initial hearing on April 14.  The case will likely not be resolved until late in the year.