Federal officials optimistic about reform, less certain about states’ role

Speaking at AcademyHealth’s annual National Policy Conference in Washington D.C. last week, Obama Administration officials and Congressional leaders expressed near certainly that a comprehensive federal health reform package will be passed in 2009 (CSPAN has posted a recording of the event).

What role the states play in creating or implementing that reform, however, is less certain.

Sen. Max Baucus, D-Montana, who chairs the Senate Finance Committee and released his own white paper on health reform in November, said that, given the nation’s current economic climate, “Our day has arrived, the voices demanding health reform have only intensified.”

“Getting health reform passed this year is my top priority,” he added. “It’s our moral obligation … (and) it may be the most important thing we ever do.”

Baucus went on to say that the “stars may have truly aligned for reform” and that reform is “nearly inevitable.”

Sharing Baucus’s optimism for passage of health reform at the conference was Jeanne Lambrew, the deputy director of the newly created White House Office for Health Reform. Echoing Baucus’s sentiments, Lambrew said that “because the economy is as bad as it is, the imperative for health care reform is even higher.”

While Lambrew and Baucus focused on the role the federal government will play in reform, several other speakers at the conference explained how states also will have an important role to play.

Kim Belshe of the California Health and Human Services said that  regardless of the work being done in Washington, states should be preparing to actively take part in reform. “I don’t think it’s enough for states to say give us money, give us flexibility and trust us,” she said. “States are going to need to make an investment themselves.”

Baucus said he saw enforcement as the primary role for states in health reform. However, John McDonough, former executive director for Health Care for All in Massachusetts and currently on the staff of the Senate Committee on Health, Education, Labor and Pensions said that in working with Committee Chairman Sen. Ted Kennedy, D-Massachusetts, he forsees the states taking on a more substantive role.

“In all scenarios, there will be a robust role for states,” he said. “The question is whether we start with a federal framework and let states that have their own plan opt out or if it is more like HIPPA, where states are able to create their own system.”