Lawmakers Discuss Role of States in Overhauling U.S. Health Care System

Lawmakers, state officials and experts on Tuesday at a House Ways and Means Health Subcommittee hearing discussed the roles of the federal government and states in efforts to expand access to health insurance, CQ HealthBeat reports.

Alan Weil, executive director of the National Academy for State Health Policy, said, "While state efforts make a real contribution, federal leadership is needed to make substantial, sustained progress in health reform efforts." Weil added, "States cannot pursue comprehensive health reform without substantial and reliable financial participation by the federal government." He said that "approaches that combine the resources, stability and uniformity of federal involvement with the dynamism, local involvement and creativity of states can foster excellent results," adding that the "federal government can bring its clout as the largest purchaser, stable funding that can weather economic ups and downs and standards that can assure all Americans they will have meaningful access to needed health care services."

Subcommittee ranking member Dave Camp (R-Mich.) said, "It is my opinion that states are the most appropriately situated to design health care plans that meet the needs of its citizens. Congress should be looking at what works, and what does not work, in the states."

Need To Improve Quality
Witnesses said that health care reform efforts must seek to improve quality and reduce costs, as well as expand access to health insurance. Weil said, "States long ago learned that they cannot afford major coverage expansions if they do not also improve the quality of health care and contain the growth in health care costs." He cited programs in several states designed to reduce medical errors, improve care for Medicaid beneficiaries with chronic illnesses and establish pay-for-performance systems. Trish Riley, director of the Maine Office of Health Policy and Finance, said that the U.S. pays for "redundancy, inefficiency, variation and oversupply" and needs to focus on efforts to address the issues in conjunction with efforts to expand health insurance to more residents.

According to CQ HealthBeat, witnesses also discussed whether "universal coverage could be obtained without some form of coverage mandate," and none "disputed that premise." However, Edmund Haislmaier, a senior research fellow at the Heritage Foundation, said that coverage gains in Massachusetts were realized as a result of making coverage more attractive through an emphasis on choice and affordability. Massachusetts Secretary of Health and Human Services Judy Ann Bigby said that the majority of state residents support the health insurance mandate recently implemented and that an estimated 340,000 residents have obtained coverage as a result.

Jack Lewin, CEO of the American College of Cardiology, cautioned against health care reform efforts that would seek to eliminate the employer-sponsored health insurance system, as they could prompt employers to drop coverage for employees (Reichard, CQ HealthBeat, 7/15).