In the States

What should be included in a health care benefit package? Balancing access to comprehensive benefits with cost is tricky business, and this dilemma is increasingly evident as many states try to cover more residents with limited access to financing.

We took this issue on the road yesterday and participated in an important discussion with state policymakers at the National Governors Association's "Defining Benefit Packages in Health Reform" meeting in Philadelphia.

There were at least three main points we took away from this conversation:

1. Financing health care must be a shared responsibility between the federal government, state government, individuals and sometimes employers, if it is to be affordable;
2. Determining the minimum set of required benefits is a value-based, community discussion that lends itself to regional differences;
3. Providing access to and incentives for preventative care is the most important goal of many state reforms.

Brief update - As expected, the Pennsylvania House did approve a scaled-back version of Gov. Ed Rendell's health coverage plan this week. Rendell has now embraced the compromise and strongly urged the state Senate—which has been more skeptical about the finances—to pass it. As coverage expansion needs to go hand in hand with insurance market reform, particularly to help small businesses and individuals purchase policies, Rendell is also pushing for an insurance package in the House. AP has the details.

Pennsylvania's House is set to approve a scaled-down version of Gov. Ed Rendell's health care plan that would cover about 300,000 Pennsylvanians.

You often hear that everyone in America gets good health care, even if they are uninsured. Sadly that's not the case. As we noted in a recent policy brief, uninsured people get diagnosed later, die sooner, and the costs get shifted to the rest of us anyway.

Iowa this week took a big bipartisan step toward covering uninsured low-income kids, but without yet settling the question of how to pay for it. The Bush Administration last year vetoed bipartisan legislation aimed at expanding SCHIP (the State Children's Health Insurance Program) and issued regulations that make it harder for states to broaden SCHIP eligibility on their own.

It's no surprise that the economy was the top issue for Mississippi voters in Tuesday's Democratic primary, but health care still resonated. Just over half the voters surveyed by network exit polls cited the economy as their top concern. But one in five said health care was their number one issue -- the same number as the Iraq war. (We would argue that health cost and coverage can be a component of economic anxiety as well).

We flew in a bunch of survivors from the California health wars the other day to share their perspective with Washington policymakers gearing up for possible national health reform next year. As we all know, a carefully crafted bipartisan compromise between the Republican Gov. Arnold Schwarzenegger and the Democratic Assembly passed that chamber by a healthy 46-31 margin last December only to fizzle a month later in the state Senate Health Committee. The seven to one "no" vote was the legislative equivalent of blunt trauma to the head. Yet we were struck by the optimistic tone of our panelists. They built powerful coalitions against difficult odds around an ambitious hybrid public-private health coverage plan. Their ability to bring stakeholders together was an important lesson as we try to prepare bipartisan, cross-sector ground for national reform next year. And instead of retreating to lick their wounds, they are thinking about how to keep cooperating in the future. One possible target: the much-publicized "rescissions" in which insurers have retroactively cancelled policies after an insured person gets sick and starts costing them money.

This grim news from San Francisco sure grabbed our attention. The city has been a pioneer in making sure the poor get access to quality health care. But now it's cutting deep into the flesh and bones of public health services for the vulnerable.