States put their own spin on Obama health care law

The Associated Press
Tuesday, March 15, 2011; 3:47 PM

CHICAGO -- Rancor over President Barack Obama's health care overhaul has largely overshadowed some states' efforts to use the law to help them move as fast as possible to insure more people and increase control over insurance companies.

Minnesota, Connecticut and Washington, D.C., have leveraged more federal dollars to expand coverage of childless adults. Vermont is exploring a single-payer health care system that would phase out most private insurance, a strategy rejected by Congress as too radical for the rest of the nation. Oregon is focusing on preventive care and providing proven treatments.

Time will tell whether these and other leader states see economic benefits from stabilized insurance markets and expanded health care coverage, or if they're haunted by their strides should the law be weakened by congressional challenges or overturned by litigation making its way to the U.S. Supreme Court.

Edwin Park, vice president for health policy at the liberal Washington, D.C.-based Center on Budget and Policy Priorities, insists there's little risk. "States are going to be able to have better functioning health insurance markets and produce significant economic gains in the long run," he said.

While some Republican states are hedging their bets - challenging the nearly 1-year-old Affordable Care Act in court as they accept multimillion dollar grants from it - several Democrat-controlled ones are pushing even further than required.

The law allows for "innovation waivers," which will be granted to states that prove their proposed alternatives to the federal requirements would cover as many people and be at least as affordable. The Obama administration supports proposed legislation that would make those waivers available in 2014, three years ahead of what the law now provides.

Vermont may seek one of the waivers. Its House is expected this month to take up legislation that would put the state on track toward a single-payer health care system, with a modest benefit package for all residents and all payments to doctors, hospitals and other providers coming from a single administrator working under a state contract.

Critics have faulted Vermont Gov. Peter Shumlin's plan to put off until 2013 decisions about how to pay for the legislation, which would create a new state board to design the system. But Shumlin and fellow Democrats who control both houses of the Legislature are pushing ahead with what they say will be a three-year effort.

Oregon has received $48 million as one of seven "early innovator" states using such funds to build the online infrastructure for an insurance marketplace. Democratic Gov. John Kitzhaber - a former emergency room physician - says he hopes to redesign his state's health care system and eliminate wasteful spending by focusing on preventive care and providing treatments proven to be most effective.

"Even if the federal government does something different, we're moving forward with major reform and I'm excited," said state Sen. Laurie Monnes Anderson, a Democrat who chairs the health committee.

Minnesota's shift to a Democrat in the governor's mansion has helped put that state on the health overhaul fast track. The state moved almost 100,000 adults into Medicaid on March 1, switching most from less generous state-paid health care programs while extending coverage to 12,000 uninsured.

Democratic Gov. Mark Dayton ordered the Medicaid expansion upon taking office in January, reversing Republican predecessor Tim Pawlenty, a potential 2012 presidential candidate who had restricted Minnesota's involvement in the health care law.

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