In 2008, three states—Iowa, Minnesota, and New Jersey—enacted substantial reforms that expanded public coverage programs and included private sector reforms. The laws encompass several components that are emerging as trends among states considering health reform. The Minnesota and Iowa laws included both coverage expansions and significant delivery system redesign. In Minnesota, the state enacted some of the most innovative and wide-reaching payment reforms of any state, including a “baskets of care” concept (on page 37) and a single statewide payment system to be used across payers. Both the Iowa and Minnesota laws included public health and wellness programs to promote healthier lifestyles among residents.
The New Jersey and Iowa reforms represent a sequential approach to health reform. Neither bill aimed to achieve universal coverage, but both explicitly pointed to future efforts to continue expanding access to health insurance. The sponsors of the New Jersey legislation have already prepared a second phase of their proposed reforms, stating that the recently enacted law is only the first step in more comprehensive health reform efforts. Iowa’s law calls for several commissions charged with considering options for future reforms. A legislatively-created council will develop a plan to cover all Iowa residents within five years.
Iowa and New Jersey set a goal of covering all children in their states. They join Massachusetts, Illinois, Wisconsin, and New York, which have set similar goals. In addition, Iowa and New Jersey are using state tax return forms to check coverage rates.
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