During this morning’s press conference, Senator-elect Scott Brown (R-MA) downplayed the importance of health care reform in yesterday’s special election and reiterated his support for leaving reform to the states. “While the health care bill was certainly an issue, the issues that were just referenced by your fellow journalists were issues that were in people’s minds,” Brown said. “You’re talking taxes and spending, terrorism and how we deal with those issues, the health care proposal, those are the more important things.”
Brown highlighted his support for Massachusetts’ 2006 health care reform bill and argued that his state may not benefit from the national effort:
We already have 98% of our people insured here. We know what we need to do to fix it, but to have the one-size-fits all plan that is being pushed nationally, it doesn’t work. So what I have suggested and what I’m hoping to suggest — because we’ve done it here, we have some experience I’ve voted for health care here so I care very deeply about it — is to let the states tell the federal government, ‘hey this is what we’d like to do. Can we work with you in a team effort, maybe you can incentivize us to do something better, model it like we have it or maybe come up with something better, so that we can learn.’
While Massachusetts adopted effective health care reforms, its success will not add up to a solution to the systemic problems plaguing American health care. As Brown himself points out, the lessons from one state tend to be just that—applicable to one but not the rest. State uninsured rates “vary from just under 8 percent to almost 25 percent and, generally, where those rates are the highest, the states have the least resources in terms of a tax base or population income levels to support funding for needed coverage expansions.” Balance budget requirements prevent many states from making meaningful long-term investments in reform and powerful health care industry lobbyists often stand in the way of reforms that could reduce industry profits.
In fact, just as Brown was suggesting “to let states tell the federal government” how they wish to reform the health care system, Kaiser News Service reported that budget woes were prompting states to cut back on existing health care programs:
– UTAH: “Utah’s Medicaid program isn’t providing enough oversight of its managed care plans, a problem that is costing the state as much as $19 million, according to a Legislative audit released Tuesday” (The Salt Lake Tribune, 1/19/2009)
– KENTUCKY: “Facing exploding growth in the government-run health insurance program for the poor and disabled, Gov. Steve Beshear’s proposed budget calls for spending an additional $782 million on Medicaid over the next two years.” However, Beshear is also calling for $108 million in cuts to the program over two years, and 2-percent nearly-across the board cuts to Cabinet for Health and Family Services programs (Lexington Herald-Leader, 1/20/2009)
– VERMONT: “Gov. Jim Douglas said Tuesday it would take $53 million in spending changes to human service programs affecting the elderly, children and the poor to close the gap between available revenues and expenditures next year” (The Burlington Free Press, 1/20/2009).
– NEW YORK: “Among the major provisions of [Gov. David] Paterson’s spending plan is a $1 billion reduction in state Medicaid spending. Paterson would achieve most of that savings by cutting Medicaid reimbursements to hospitals and nursing homes” (The (Elmira, N.Y.,) Star-Gazette, 1/19/2009).
States don’t have the economic, political or structural capacity to invest in something as big as health care reform and too many are already struggling to maintain their Medicaid programs in the face of enrollment increases. Political considerations, special interest influences and budgetary strains have doomed previous state-based health care reform efforts and exporting reform to the states is just another way of killing it.