By Rebecca Mayo, J.D.
A new study in the New England Journal of Medicine found that the chaotic, hyperpartisanship environment in Washington does not necessarily reflect on the potential for bipartisan agreement on issues surrounding health care at the state level. While Washington may be taking steps to undermine the Affordable Care Act (ACA), the states are claiming an increasingly large role in health policy and Democratic and Republican state policymakers appear to agree on many of the key issues.
The study. Surveys were sent to all state legislators serving on committees related to health, asking them to rank their policy priorities. Kansas was selected to represent the 26 states led entirely by Republicans and Colorado was selected to represent the 18 with split control. Legislators, executive-branch leaders, and key stakeholders were asked about the results of the nationwide survey.
Policymaking. The results of the survey and the discussions with representative states showed that both parties seem agree on many of the key health care reform issues facing states right now. They first noted that leaders expressed near-universal disdain for what was described as a dysfunctional and chaotic environment in Washington which makes it difficult for state leaders to plan for the long-term. Both parties acknowledge that it will be impossible to eliminate the role of government in health care, and turn instead to discussing how the public sector can get the most value for what it spends.
Access and cost. A top priority for policy makers is access to health care, both insurance and providers, especially in rural communities. In some states, Republicans are working to expand Medicaid in order to keep rural hospitals open. From the conversations with policy makers it appears that there may be quibbles about the ACA, but "there does not seem to be an appetite for a large-scale rewrite." Both sides also seem to agree that reducing costs is important, however there are disagreements about the root of the problem and whose costs need to be reduced.
Moving forward. States claiming an increasing role in health policy has the advantage of more closely reflecting local politics. However, durable legislation is more likely to happen with leadership that is less ideologically driven, meaning even in states controlled entirely by one party, bipartisan agreement remains necessary. The authors note that as we enter into this period of state-level experimentation, there is an opportunity to develop evidence about the effects of everything from Medicaid work requirements to housing vouchers and it will be important to develop reliable data about the effects of state decisions.
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