WASHINGTON — Massive budget shortfalls in 40 states, coupled with greater demand for Medicaid coverage, made it tough for states to expand health care coverage for their residents last year, according to the annual survey of state health care and insurance legislation done by the Blue Cross and Blue Shield Association.
However, the Recovery Act (formally known as the American Recovery and Reinvestment Act of 2009)—promises to make things easier in 2009, according to Susan Laudicina, director of state policy and research at the Blue Cross and Blue Shield Association. “The money in the [recovery] act is certainly going to help states avoid deep cuts to the Medicaid program. Is it adequate? Probably more money is needed.”
Nevertheless, according to Ms. Laudicina, states see better times ahead. “What's happening right now is governors are actually redoing their budgets.
“States are immediately factoring in [the stimulus money]. In many cases, it is closing the budget gap, and in some cases, they are avoiding cuts. “Is it going to close all gaps? No.”
According to the annual State of the States report, the economic crisis meant that most expansion efforts fell short in 2008, even in high-profile states with governor backing, like California, New Mexico, and Pennsylvania.
“There has not been a consensus [to mandate universal coverage] since Massachusetts, now going on 3 years ago,” said Ms. Laudicina. Still, some states, including Connecticut, Hawaii, Minnesota, Oregon, and Washington, are now developing universal care strategies that they will try to pass into law in 2009.
“Now that Obama is pledging to reform some things this year, and put $634 billion in his budget for use in future reforms, does that mean the states are going to hold off [on these plans]?” said Ms. Laudicina in an interview.
“Frankly, since we don't know when a national health care reform bill will be enacted, we don't know the tools that will be used. … I expect that states such as Oregon … and Minnesota and Connecticut that are interested in creating commissions are going to go ahead with their plans. They're going to plan all they can. They're going to assume that they're going to be big players in whatever national bill comes down the pike.”
The State of the States report also showed that expansion of coverage for children was not spared from states' fiscal problems last year, according to the report.
However, some states, including Colorado, Florida, Kansas, and Minnesota, did modestly expand their Children's Health Insurance Programs (CHIP).
In New Jersey, the Health Care Reform Act (S. 1537) mandated coverage for all children under age 18 years, though without any minimum benefit requirements. “Parents can comply with the mandate program by purchasing a licensed private product or by enrolling in Medicaid or CHIP,” according to the report. However, the funding source for such an expansion has yet to be determined, as does the enforcement mechanism.
The survey also reported on health care transparency efforts. In the 20 states that introduced such bills in 2008, nine laws were enacted, Ms. Laudicina said. Some of these, like H.B. 1393 in Colorado, require hospitals to display charges for common inpatient procedures on a publicly accessible Web site.
Others, like Louisiana's Right to Know Act (S. 287), require that the state's department of health and hospitals display not only cost information, but also data on quality measures among medical facilities, individual physicians, and health plans.
Regarding health information technology measures, Ms. Laudicina said that over the past 3 years, 33 states have enacted legislation promoting the adoption of electronic medical records, and bills are pending in 12 more. And the financial incentives for electronic medical records adoption in the stimulus package should mean that even more physicians and facilities implement them voluntarily.
Other proposals considered by states in 2008 included mandated coverage of adult dependent children until age 25, 26, or even 30 years, said Alissa Fox, senior vice president of the Office of Policy and Representation at the Blue Cross and Blue Shield Association. This possibility will remain on states' agendas in 2009.
The report is based on a survey of the 39 independent Blue Cross and Blue Shield companies across the nation.
For details on how individual states will implement stimulus funds, Ms. Laudicina recommended the National Governor's Association Web site, at www.nga.org/arra