Given the lack of major health reform at the national level and the momentum created by new reform measures passed by Kentucky, Massachusetts, West Virginia, and others, there is growing bipartisan support among federal legislators for states to serve as "learning laboratories." Several pending legislative bills would provide federal funds to states for pilot projects and other health reform initiatives. If none is passed in the remainder of the current legislative session (the 109th Congress), some are likely to be reintroduced next year.
- Health Partnership Act (S2772) Introduced by Senator Voinovich (R-OH) and cosponsored by Senators Akaka (D-HI), Dayton (D-MN), and DeWine (D-OH), this bill would establish a State Health Innovation Commission with a number of roles: 1) to provide states with reform options for health care expansion; 2) to establish minimum performance measures with respect to coverage, quality, and cost of state programs; 3) to review states' applications; and 4) to submit to Congress a list of applications it recommends for approval.
Any state with an application approved would receive a grant from the Department of Health and Human Services to help implement its innovative program. By accepting the grant, a state must agree to maintain its health care coverage expenditures at a level at least equal to that incurred during the previous fiscal year. The state is also prohibited from limiting eligibility for state medical assistance programs, or imposing any preexisting criteria exclusion on covered benefits (with exceptions). The bill is intended to support state reforms that expand coverage and access to health care, and enhance quality and efficiency. It is endorsed by the American Hospital Association, the American Medical Association, and the National Governors' Association. For more information go to http://thomas.loc.gov/cgi-bin/query/z?c109:S.2772. - Health Partnership Through Creative Federalism Act (HR5864) Introduced by Representatives Baldwin (D-WI) and Price (R-GA), and cosponsored by Representatives Beauprez (R-CO) and Tierney (D-MA), this bill would provide federal grants for a diverse set of state initiatives to expand coverage and access, similar to the Senate bill discussed above. These initiatives either would build on current strategies, such as tax credits, Medicaid or SCHIP expansions, purchasing pools, individual market options, single-payer systems, health savings accounts, or any combination of the above, or develop a new option. Applications could be submitted by a governor or state agency or agencies, and decisions would be made by a State Health Coverage Innovation Commission comprised of 19 members, including the Secretary of the Department of Health and Human Services and selected appointees from the state and federal level. Unlike S2772, the House bill has a budget-neutral provision requiring that the new initiatives have no net cost beyond the five-year grant appropriation. For more information go to http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.05864:.
- Catastrophic Health Coverage Promotion Act (S3701) Introduced by Senator Smith (R-OR) and cosponsored by Senator Wyden (D-OR), this bill would support six state demonstrations to develop methods for providing protection from catastrophic health expenses for individuals who have exceeded their health coverage's lifetime limits. The demonstrations will utilize state risk pools, reinsurance mechanisms for small businesses, and/or public private partnerships. For more information go to http://thomas.loc.gov/cgi-bin/query/z?c109:S.3701:.
- State-Based Health Care Reform Act (S 3776) Introduced by Senator Feingold (D-WI), this bill would ensure the provision of high-quality health coverage for the uninsured via state-based initiatives. Seventy-five percent of the funding for these initiatives would come from the federal government, with a 25 percent state match. State strategies may involve promoting health savings accounts, expanding Medicaid, using private insurers, or developing single-payer plans. A federal task force would review the applications and decide which proposals to fund. For more information go to http://thomas.loc.gov/cgi-bin/bdquery/z?d109:s.03776:.
