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Monday, September 14, 2009

Bill Needs States' Flexibility

By Max Bartlett And Jose Aguilar
Health Security for New Mexicans Campaign
          As the struggle over national health care reform intensifies in Congress, a great deal of attention has focused on a variety of concerns, especially whether a public plan needs to be included in the legislation. There is, however, one issue that has not been discussed: whether states should have the right to develop their own approaches to universal coverage.
        The Health Security for New Mexicans Campaign wants to see language included in national legislation that gives states the flexibility to develop their own approaches to solving the problems of growing numbers of uninsured and rising health care costs.
        Currently, draft health care reform legislation in both houses of Congress only allows states to set up "insurance market exchanges." These one-stop-shopping insurance exchanges must offer consumers — primarily the uninsured — choices of different insurance products, including a public plan option (this option may be dropped from the legislation altogether, despite polls indicating that the majority of Americans support it).
        States have always been laboratories for innovation. Women's suffrage, civil rights, child labor and minimum wage laws were developed in the states first — then became federal law. Why shouldn't states be allowed to continue that role? If a state can develop an approach that is not based on the insurance market exchange model, an approach that still provides comprehensive coverage for its residents and contains rising health care costs, why shouldn't it be encouraged to do so?
        In our state, the Health Security Act offers a different solution from one that is based on an insurance market exchange. It is a home-grown solution that has earned enormous public support: 146 diverse organizations are part of our coalition, and 32 New Mexico counties and municipalities have passed resolutions endorsing it.
        The Health Security Act would enable New Mexico to set up its own health care plan that would automatically cover most New Mexicans, providing comprehensive benefits, and guaranteeing freedom of choice of doctor (even across state lines).
        Instead of creating a system of competing insurance plans, each with different provider networks, this proposal would shift the role of the private insurance companies to providing supplementary coverage — as they do with Medicare. Any individual, employer or group that wished to purchase additional coverage could do so. A non-governmental, geographically representative citizens' board would be in charge of the plan. Two separate studies have concluded that if such a health plan were established in New Mexico, health care costs would be reduced by hundreds of millions — if not billions — of dollars, within five years of beginning operation.
        Why is this so? Because this approach simplifies a very complex private insurance system with its hundreds of policies, different benefits, co-pays and deductibles, all of which impact the administrative overhead of doctors, hospitals and clinics — and which, in turn, negatively affect health care costs.
        In a state such as ours, with its small population, it makes a lot of economic sense for most residents to be covered under one health risk pool.
        Aside from the strong economic reasons, setting up our own publicly accountable plan would make it easy for New Mexicans to be involved in the decision-making process that would occur during the three-year development phase and once the plan is in operation. Not many of us are able to go to D.C. to participate in public hearings regarding the national health reform proposals.
        Coalitions in other states — California, Minnesota, New York, Pennsylvania, Washington and Oregon, to name a few — have been working on proposals that do not depend on a private insurance paradigm and are adapted to the particular needs of those states.
        Acknowledging these developments, the National Conference of State Legislators recently passed a resolution, which contained a provision asking that states be allowed to create solutions that go beyond federal requirements. New Mexico was counted as one of the resolution's supporters.
        In addition, state Sen. Dede Feldman and other New Mexico legislators sent a letter to our five-member congressional delegation including a request that states be given the flexibility to develop their own comprehensive plans.
        The federal bill clearly needs to encourage state experimentation. Aside from the need for state flexibility in the national legislation, the Health Security for New Mexicans Campaign believes that states that decide to develop their own health plans should have the right to access the same federal dollars as those states that choose to set up their own insurance market exchanges.
        If we want New Mexico to be able to establish its own health plan — one that we control and does not rely on our currently complex, costly private insurance system — then our congressional delegation must hear from us that we want state flexibility language included in federal health care legislation. They need to hear from us now.
        Max Bartlett and Jose Aguilar are the chair and vice-chair, respectively, of the Health Security for New Mexicans Campaign.
       

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