At this week’s CSG-ERC
Annual Meeting in CT, state policymakers from across the Northeast got
updates from experts on the federal health care landscape, state options to
adapt. CT’s Lieutenant Governor Nancy
Wyman pulled it all together describing CT’s progress toward health reform.
Mitchell Stein gave a detailed summary of federal activity including CHIP
reauthorization (ends Sept. 30 without action), tax bills and raising the debt
limit which all could impact Medicaid and/or the Affordable Care Act. He
re-capped ACA repeal efforts and the status of insurance exchanges including
cost-sharing reduction payments, underserved counties, premium levels and
degradation of the risk pool. It’s estimated that about half of premium rates
for next year are due to uncertainty about ACA implementation. He outlined what
is likely to happen this fall and potential state responses including reinsurance
waivers and creating a Medicaid buy-in option.
Policymakers then heard from Chris Koller,
President of the Milbank Memorial Fund, on the big picture and states’ capacity
to address the quickly changing environment. He reminded policymakers about the
importance of social services in health outcomes and America’s poor performing
health system that costs more and delivers less than other countries. He
outlined concerns about slow economic growth’s impact on the health of poorer
populations and government’s ability to address that stress, rising health
disparities, and political changes. Probably his most popular slide described
the results of a Milbank survey of state legislators finding that Democrats and
Republicans have very different goals and values for health reform. Republicans
are most interested in reducing costs while Democrats prioritize improving
health and equity. The federal government is delegating more health policymaking
to states, while Medicaid costs rise, crowding out other priorities. In good
news, he highlighted Georgia’s progress in reducing infant mortality, and
Delaware’s success in addressing chronic illnesses, with lessons learned. He
emphasized that states need to get creative in building state health policy
capacity and shared a roadmap to get there.
Lieutenant
Governor Nancy Wyman ended the meeting by recapping what we heard and
describing CT’s long history of success in reforming health care and expanding
access. She outlined work creating AccessHealthCT, outreach efforts that cut
CT’s uninsured rate in half, Medicaid reforms, and support for primary care and
prevention with the state employee plan’s Health Enhancement Program.
This was followed by a lively question and answer discussion
touching on the relationship between health care industries and jobs, state
options to create a reinsurance program and/or require all individual coverage
be sold on the insurance exchange, the role of 1332 waivers, the role of family
caregivers, end of life care costs, and comparisons with the Canadian system.
More information on state reinsurance programs and Medicaid
buy-in options will be coming.
