David Williams of Health Business Blog has written an interesting article about why states can’t drive health care reform. I agree, and believe that in order to have meaningful change, it will need to take place on a federal level. One of the issues that David addresses is the problem that occurs when a state enacts tough legislation and insurance companies simply choose to operate in states with more lenient regulations. There are already a wide range of laws on the books pertaining to health care in each of the 50 states, and it is absolutely the case that insurance companies and health care providers will consider those regulations when deciding where to do business. In Colorado, we have a wide range of options available for people seeking individual health insurance plans, but in NY, where individual policies are required to be guaranteed issue, there are only a handful of very expensive policies from which to choose.
We currently have 50 states with 50 different levels of health care regulation. For people who are ill, some states are much better places to live than others. State-driven health care reform could theoretically be expected to increase the populations of sick people in states with very patient-friendly laws, thus driving health care costs even higher in those areas. No state is an island.
Since much of the health care reform debate comes down to money, I think David’s comment that “…the federal government has an easier time running large deficits than the states do.” is the most pertinent point of all. Basically, the logistics of genuine health care reform could bankrupt many states. It might run the federal government into a good deal of debt too, but the feds have more avenues for dealing with debt than the states do.
I feel fortunate to live in a state where we have a solid high risk pool (Cover Colorado) and lots of options for policies in both the individual and group market. But I can’t help but think of people who live in states where there aren’t any health insurance policies available to people who are sick and not covered by an employer’s plan. Or people who live in states where health insurance is guaranteed issue but not mandatory, and thus extremely expensive. For them, health care reform on a state level has a long way to go, and might not happen at all.
David’s article was included in last week’s Health Wonk Review, hosted by Brad Wright at Wright On Health.