Health Reform Has Fiscal, Political Burdens For States

"Bills in both the Senate and the House of Representatives would make more people eligible for Medicaid, the health insurance program for the poor that states administer with reimbursements from the federal government," Reuters reports. The news service also notes that a mandate that people get coverage could mean rolls swell for the state-run programs that insure the poor. That could leave states "staring at spending millions of dollars they do not have to provide insurance to more people, officials said on Tuesday." In the House bill, the federal government would pick up the costs of the new Medicaid recipients for the first two years, but after that, states would have to pay a percentage. In California, officials are already concerned that the state can't afford the program at its current scope (Lambert, 11/10).

Meanwhile, The New York Times reports that "In the two weeks since the Senate majority leader, Harry Reid, embraced a proposal that would allow states to opt out of a new government health insurance plan, state leaders have begun debating whether to take part, and the question has emerged as a litmus test in some campaigns for governor. The proposal, which is being woven into the Senate health care bill, would shift some power to the states and would foist upon state leaders the burden of a choice that, in some cases, could pit principle and politics against pragmatism. States would be given the right to opt out of only the public plan, not from the tax increases needed to subsidize coverage for the uninsured."

Many governors – including Republicans – "see little to gain from denying constituents an insurance option that could help slow the growth of premiums at no immediate cost to the state… But in some conservative states, the public option… is such an anathema that lawmakers and governors may choose to stand against it" (Sack, 11/10).

While national plans may impose some burdens on states, going it alone on health care can also be tough. In a separate article, The New York Times reports: "Maine is the Charlie Brown of health care. The state's legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded… But like the Peanuts character, the state keeps trying" (Harris, 11/10).

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