Policies to solve the health care crisis of unaffordable health care and lack of access for millions of Americans is a key challenge and opportunity for progressive state leaders, who are enacting innovative proposals that are models for extending quality, affordable health care to all our states’ residents:

* Covering All Kids: While state efforts to cover all kids, largely through expanding the state-federal State Children’s Health Insurance Program (SCHIP), were dealt a serious blow by President Bush’s refusal to approve long-term expansion of the program and new restrictions sent down in August, key bills have been models for improving access to coverage for children. Illinois’ AllKids program is ambitiously extending its program to all children in the state based on sliding scale premiums. New Jersey in recent years brought eligibility to 350% of poverty and New York last year authorized expansion of the program to 400% of poverty. Although the Bush Administration is fighting these expansions, continued state pressure will help ensure the federal government gets its act together on kids health care. Elsewhere, Hawaii advanced a bill eliminating cost-sharing in its children’s health program up to 300% of the poverty. And, Washington State advanced a first-in-the-nation provision creating a children’s health care entitlement program which will guarantee funding for children’s health care up to 250% of poverty, exempting the state’s kids program from yearly budget battles. 

* Quality Affordable Health Care for All Residents: Following Maine, Massachusetts, and Vermont, states are increasingly moving comprehensive reform proposals.  Approaches being pursued range from California’s public-private partnership with similarities to the Massachusetts plan, to a single-payer plan in Pennsylvania, to Wisconsin’s Healthy Wisconsin plan which is being refined for the 2008 legislative session and would guarantee comprehensive health care for all Wisconsin residents. Building on smaller employer “pay-or-play” requirements in Massachusetts and Vermont, San Francisco has advanced a more robust requirement for employers to spend a certain amount on employee health care benefits or make a contribution to the city to finance health care expansions. 

* Health Care Reform Commissions: Commissions can be effective tools for building public awareness and support for health care reform and for states to study the best options for comprehensive reform in their state. The Colorado Blue Ribbon Commission for Healthcare Reform, created by 2006 SB 208, spent 2007 engaging the public and studying reform proposals ranging from a single-payer system to an incremental public-private expansion of coverage. 

* Health Care Cost Savings: A slew of options are available to reduce prescription drug costs and limit industry profiteering. These include: marketing disclosure and provider gift bans; Minnesota gift ban and disclosure laws; drug discount programs like Maine Rx and Colorado Cares; other 340B drug discount programs; state false claims acts, mirroring the federal law, to identify and prevent Medicaid fraud; and, Maine’s best price disclosure law. In 2007, Washington lawmakers enacted HB 2098 which includes a number of provisions to develop a pay for performance system to recognize and incentivize provider quality amd promote best medical practices, a model similar to the Maine Quality Forum. 

* Health Insurance Regulation: To limit profits and inefficient administration and ensure more premium dollars go to direct medical care, states can establish a medical loss ratio.  These rules require insurance companies to spend a certain amount of premiums on medical care, such as 85% which is being proposed in California. Elsewhere, in 2007, Colorado enacted small group community rating standards that prevent insurance companies from hiking premiums on older employees and employees with a medical history or poor health status.