The State Scene: Health Care Initiatives, Roles

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The State Scene Health Care Initiatives, Roles
Opportunities

• Prepared for Family Voices
• May 4, 2009, Washington, D.C.
• Martha King
• National Conference of State Legislatures
• Martha.king_at_ncsl.org
• 303-856-1448

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Legislators Why Should You Care?

• States will remain instrumental in health reform
• "People's Branch" of Gov't
• Control the purse tring
• Establish programs Enact requirements
• Provide oversight
• States have been called the "laboratories of
  change" for health issues

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Variety in State Legislatures

• If you've seen one legislature, you've seen just
  one!
• Different cultures, powers, rules, procedures,
  etc.
• California
• -Full-time job
• -Members earn gt100,000 year
• -Large staff (non-partisan, partisan, personal)
• Wyoming
• -40 day general session, 20 day budget session
• -Members earn 150 day for short time
• -Approx. 20-25 full-time professional staff

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Red, White and Blue Legislatures
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Extra Challenges Term Limits

• 15 states currently have term limits
• AR, AZ, CA, CO, FL, LA, ME, MI, MO, MT, NE, NV,
  OH, OK, SD
• Experience institutional knowledge loss
• Continuing education process
• Severe transitions in some states
• Missouri House 2002 45
• Michigan Senate 2002 71
• California Senate 2006 33

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Legislators Are Generalists

• Dozens of topics
• A to Z
• Hundreds of bills
• Cant be experts in all

• Agriculture
• Corrections
• Education
• Health
• Housing
• Human Services
• Labor
• Transportation
• Zoning . . .

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Health Issues by the Dozens

• Medicaid
• Insurance/mgd care
• Pharmaceuticals
• Long-term Care
• Uninsured
• Health professions
• Health Facilities
• Environmental
• Public health

• SCHIP
• Prenatal Care
• EMS
• Nutrition
• Oral health
• Injury prevention
• Mental Health
• Disabilities
• Substance Abuse
• etc. ...

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Your Roles

• The blip enlarger!
• Expert
• Information resource
• Advocate
• Networker

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Getting Their Attention Barriers

• Competing needs and demands
• Budget issues competition
• New legislators ( 20 turnover)
• Lack of awareness/understanding
• Relative size of the issue
• Limited time resources
• Complexity of cross-cutting issues

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State Challenges Decision-Making

• Several departments
• Several committees categorical bills
• Line-item budget
• Must balance the budget
• Unanticipated consequences
• Penny-wise and pound foolish

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Dos and Donts Working with Legislators

• DO
• Get involved (year round)
• Be accurate, reliable, honest, concise, and
  vigilant
• Build relationships early
• Reach out to new members
• Offer to be a resource
• Be inclusive of others
• Have written materials
• Personalize the issue/take a field trip
• Thank your audience

• Dont
• Assume you dont count
• Mislead or give false information
• Make enemies
• Wait until session
• Be too narrowly focused
• Refuse to compromise
• Go on and on . . .
• Give up

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Things to Think About ...

• What type of information do policymakers need?
• Do your homework?get your facts
• Be accurate, brief concise
• Personalize the issue
• Be vigilant
• Follow-up if they need more
• Offer to help
• Illustrate your facts

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Things to Think About ...

• What type of information do policymakers need?
• Do your homework?get your facts
• Be accurate, brief concise
• Personalize the issue
• Be vigilant
• Follow-up if they need more
• Offer to help
• Illustrate your facts

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Distribution of the Average States Budget for
Health Services
Source Milbank Memorial Fund, National
Association of State Budget Officers and The
Reforming States Group, 2002-2003 State Health
Expenditure Report (New York Milbank Memorial
Fund, 2005), http//www.milbank.org/reports/05NASB
O/index.html
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State Authorized Childrens Eligibility for
Medicaid/SCHIP by Income, January 2008
NH
VT
WA
ME
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
WV
DE
NV
IL
UT
VA
MD
CO
CA
MO
KS
KY
NC
DC
TN
SC
OK
AR
AZ
NM
GA
AL
MS
TX
LA
AK
FL
HI
lt 200 FPL (6 states)
200-250 FPL (22 states)
Effective gt250 FPL (23 states)

The Federal Poverty Line (FPL) for a family of
three in 2007 is 17,170 per year. Effective
eligibility higher than 250 FPL accounts for
earnings disregards. IL uses state funds to
cover children above 200 FPL. SOURCE Based on
a national survey conducted by the Center on
Budget and Policy Priorities for the Kaiser
Commission on Medicaid and the Uninsured., 2008.
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Opportunities

• Covering more kids
• Ensuring that needed services are provided
• Improving coordination with other services
  programs
• Highlighting resources such as Title V, Part H,
  etc.

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FY 2009 Budget Gaps as a Percentage of General
Fund Budget
Source NCSL survey of state legislative fiscal
offices, January 2009.
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FY 2010 Budget Gaps as a Percentage of General
Fund Budget
Source NCSL survey of state legislative fiscal
offices, January 2009.
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Economic Stimulus Package

• American Recovery Reinvestment Bill
• Medicaid relief coverage for the unemployed
• Health Information Tech
• COBRA (extend health coverage)
• Prevention Wellness
• Workforce Health Centers

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Renewed Health Reform Debate Opportunities

• More people realize the current way of business
  is unsustainable
• More people realize that costs are out of control
• The states have been very active in the health
  reform debate innovative ideas
• The national level seems ripe for change

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Health ReformDecision-Making

• First, define your goals
• Healthier population?
• Universal coverage?
• The right services for the right people at the
  right time?
• Other?
• You cant get there if you dont know where
  youre going . . .

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Health ReformElements of "Success

• Political will
• Leadership
• Involve stakeholders (bi-partisan, employers,
  insurers, providers, consumers, etc.)
• Use multiple strategies (e.g., strengthen
  employer coverage, expand public programs,
  protect the safety net)

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Health Reform Trends

• Incremental reform
• Insure additional people
• Examine benefits mandates
• Prioritize kids
• Spread the responsibility (e.g., individuals,
  employers, government)
• Disease case management
• "Quality" and value purchasing
• Some focus on wellness prevention

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"Health Reform"What it's not

• If we just do the same stupid stuff, only more of
  it or faster, then it's not effective health
  reform
• (Paraphrasing Len Nichols, Director, Health
  Policy Program, New America Foundation)