WASHINGTON — With health care expenses accounting for the single largest expense in their budget, states are increasingly looking for solutions from within, not from the federal government, according to an annual accounting of state legislative trends compiled by the Blue Cross and Blue Shield Association.
“Health care spending represented nearly one-third of total state expenditures last fiscal year,” commented Susan Laudicina, who is BCBSA director for state research and policy, during a briefing for reporters.
As the economy weakens, health care costs will continue to rise, while tax revenues will fall, she noted.
“The challenge for state lawmakers is how to avoid cutting existing programs like Medicaid and the State Children's Health Insurance Program while also finding new ways to cover the uninsured and contain costs,” Ms. Laudicina said.
About half of the state legislatures debated establishing universal coverage or expansion programs for children in fiscal 2007.
Mandates requiring individuals to buy insurance were introduced in 12 states but failed, largely because such mandates are controversial, she said.
Connecticut and New York expanded eligibility for SCHIP to 400% of the federal poverty level and seven other states raised eligibility to 300%, but those efforts are threatened by a rule change issued by the U.S. Department of Health and Human Services last August that ostensibly caps eligibility at 250% of the federal poverty level.
Eight states—Connecticut, Indiana, Kansas, Louisiana, Maryland, New York, Texas, and Washington—created programs that use public funds to subsidize private employer-sponsored health insurance in order to make it available to Medicaid-eligible workers.
In addition, “transparency” initiatives—which are proposals requiring hospitals (and, in some cases, physicians) to publicly share information on adverse events, quality data, and pricing—are gaining ground.
Transparency bills were enacted in Arkansas, Delaware, Georgia, Indiana, Minnesota, New Jersey, Oregon, Pennsylvania, Texas, and Washington.