By Norman Thurston, Ph.D.
State Health Reform Implementation Coordinator
In the past few weeks, the U.S. Department of Health and Human Services (HHS) has released five separate proposed rules regarding states’ role in federal health reform (see links below). Our health reform staff is currently working our way through each of these and we hope to provide detailed comments and responses to HHS by the corresponding deadlines. Those comments will be made available for the public to review as they are submitted, no later than September 28 for the first two, and October 31 for the others. Other Utah stakeholders should also consider responding.
It has been Governor Herbert’s position all along that the states are the most appropriate and relevant agents for implementing meaningful health system reform. Justice Louis Brandeis famously wrote:
Denial of the right to experiment may be fraught with serious consequences to the nation. It is one of the happy incidents of the federal system that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.
If each state were allowed to undertake health system reform in a way that makes sense for its respective population and circumstances, we would learn a lot from each other’s successes and failures. Only then might it actually be possible to find effective and workable solutions which could be implemented on a national basis. A one-size-fits-all or top-down approach is likely to be counterproductive and frustrating.
At the same time, there are requirements of the Patient Protection and Affordable Care Act (PPACA) that really cannot be done well at the state level, should the law withstand the constitutional challenges which have been filed against it by the majority of the states, including Utah. If we can identify those provisions which should clearly be handled at the federal level (again, assuming the law stands), we should be able to send a clear message about what the states are not willing to do so that they can be handled at the federal level instead of forcing states in to inappropriate areas.
Utah has been a leader in exploring and testing possible solutions. We’re seeing steady enrollment growth in the Utah Health Exchange since its full launch at the beginning of the year, and our efforts are drawing national attention. Given our experience in operating one of only two functional exchanges in the country, we will probably have a lot to say about these rules, making some strong arguments for greater flexibility and freedom for states.
As we continue to work on this critical task, we hope that our federal counterparts will continue to support state-level solutions with flexibility and recognize areas where states should not be forced to implement.
Links to HHS Proposed Rules:
1. The establishment of exchanges and qualified health plans: http://frwebgate2.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=eC7uKU/0/2/0&WAISaction=retrieve
2. Reinsurance, risk corridors and risk adjustment: http://frwebgate2.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=dGXXzL/0/2/0&WAISaction=retrieve
3. Medicaid program eligibility changes: http://frwebgate3.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=OHepQz/0/2/0&WAISaction=retrieve
4. Exchange eligibility determination standards for employers: http://frwebgate3.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=2l2VGW/1/2/0&WAISaction=retrieve
5. The health insurance premium tax credit: http://frwebgate3.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=38icWx/3/2/0&WAISaction=retrieve