Implementing HIPAA State Budgets, Elections, and Policy Priorities

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Implementing HIPAAState Budgets, Elections, and
Policy Priorities
Presented by Robert J. Burns NGA Center for Best
Practices

• National Association of Health Data Organizations
• 17th Annual Meeting
• Atlanta, GA December 2-3, 2002

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State Budget Overview

• States closed 37.2 billion budget gap during
  FY2002
• 46 states reported budget deficits
• Revenues 1.2 percent less than expected
• Spending 1.8 percent more than expected
• States face 49.1 billion budget gap going into
  FY2003 (projections)
• 3.7 percent revenue growth (projected)
• 1.6 percent spending growth (projected)
• Year-end balance will decline 3.7 percent
  (projected)
• Source National Conference of State
  Legislatures, August 2002

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Revenue Enhancements
During FY2002 Into FY2003
Budget cuts 29 states 26 states
Other state reserves 20 states 23 states
Tobacco settlement funds 12 states 16 states
Taxes 16 states 16 states
Rainy day funds 19 states 12 states
Other fees 13 states 10 states
Source National Conference of State Legislatures, August 2002 Source National Conference of State Legislatures, August 2002 Source National Conference of State Legislatures, August 2002
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Gubernatorial Elections 2002

• 36 governorships up for election
• 14 term limited
• 6 voluntary withdrawals
• 16 incumbent challenges
• 11 incumbents returning
• 24 new Governors assuming office
• Party changes in 20 states

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Gubernatorial Changeovers(even years only)
2002 25
2000 7
1998 14
1996 5
1994 21
1992 11
1990 18
1988 6
1986 22
1984 11
1982 18
Source National Governors Association, November
2002
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• The chief executive of a state today holds
  more power and sway over the public purse and
  policyand likely presents more of a leadership
  profile in the state than any other office holder
  other than the President.
• Ray Sheppach
• Executive Director
• National Governors Association

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Gubernatorial Powers(that do not require
legislative approval)

• Submit the state budget
• Establish policy priorities
• Set spending targets
• Veto components of legislative budget
• Appropriations
• Selected words
• Change meaning
• Line item
• Cut the budget
• Reorganize departments
• Spend unanticipated federal funds

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Implications

• New priorities
• Energy, enthusiasm, personality
• Relationship with the public
• Relationship with legislature
• New appointees
• Commissioners, deputies, senior staffers
• Administer the Governors policies
• Advance the Governors issues

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Top Campaign Priorities(Governors-Elect)

• Fostering economic recovery (balancing state
  budgets)
• Bolstering homeland security
• Maintaining education initiatives
• Containing health care costs

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Top Health Priorities(Governors-Elect)

• Containing pharmaceutical costs
• Leveraging Medicaid and SCHIP
• Bolstering the health care workforce
• Financing long-term care

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Why Still Emerging?

• Legally Complex
• Privacy
• New terms and interpretations
• Technically Complex
• Electronic transactions
• Electronic data interchange
• Poor Guidance
• Staggered rule making
• No arbitration process
• No validation

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Prioritizing HIPAA

• What does a Governor really need to know about
• HIPAA implementation?
• Worsening the budget situation
• Impeding access to health care
• Affecting the quality of care
• Threatening provider solvency
• Impairing state-level program administration
• Hindering ability to make good policy decisions

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Recommendations

• Get to know the new Governors staff
• Get to know the new Governors priorities
• Offer solutions
• Be practical (political, fiscal reality)
• Build consensus
• Identify resources
• Learn to speak the language

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NGA Center for Best Practices(http//www.nga.org/
center)

• Robert J. Burns
• Policy Analyst
• Health Policy Studies Division
• National Governors Association
• Center for Best Practices
• Hall of States, Suite 267
• 444 North Capitol Street, NW
• Washington, DC 20001-1512
• [phone]
• fax [phone]
• email rburns_at_nga.org