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The politics of Healthcare need reform

What is happening in the Individual States and Unique Populations

Data from around the country.


A new Rasmussen survey finds 37 percent of the people in Massachusetts think the state's reforms have been a failure, 26 percent think they have been a success, and 37 percent are not sure. Ten percent think quality of care has gotten better, while 29 percent say it has gotten worse, and 21 percent say health care has gotten more affordable and 27 percent say it is less affordable.

SOURCE: Rasmussen Reports


Tarren Bragdon of Maine's Heritage Policy Center had an op-ed in the Bangor Daily News last week. In it he warns against the so-called public option and says Maine's Dirigo Care should serve as a lesson on what not to do in health reform. He says the state has spent $155 million over five years to cover a mere 3,467 previously uninsured Mainers. When the law was passed the state assumed so many people would be insured that hospitals and insurers would no longer have uncompensated care costs, so it was going to pay for the public insurance by assessing those companies. This is the same sort of wishful thinking currently pervading Washington.

Of course, nothing of the sort ever happened and the state had to scramble around for other ways to pay for its ambitions. It enacted a new tax on beer and soft drinks that was promptly repealed by the voters in a referendum. Now it doesn't know what to do and has frozen enrollment since September, 2007. Mr. Bragdon concludes, "Maine's Dirigo experiment has been a costly failure. Dirigo's government option has not covered the uninsured. Dirigo's government option has resulted in a new tax on the hundreds of thousands of Mainers struggling to afford private coverage."

SOURCE: Bangor Daily News

More Maine

Of course, Maine is also home to two "moderate" Senate Republicans, so is becoming a hot bed of political lobbying, according to The New York Times. The Left there is trying to dismiss the experience of Dirigo. The article quotes a Bonnie Roberts as saying, "You can't try to fix this state by state." Somehow she thinks the federal government will be exempt from these lessons. That view is countered by Mike Marcotte, an accountant from Lewiston, who says, "They (Senators Snowe and Collins) need to vote for free enterprise. Less government is better."

SOURCE: The New York Times

Another Maine update

Maine enacted universal coverage in 2005, also with no cost constraints. Premiums for the state-financed insurance plan have risen 74% since, and many residents have dropped coverage. Maine's uninsured rate is back at 10%, barely lower than the pre-reform level.

SOURCE:  BusinessWeek


The Arizona legislature is taking another run at the "Freedom of Choice in Health Care Act" that was on the ballot last year and lost by a mere 8,000 votes out of 1.8 million cast. Last year's measure was vehemently opposed by Democratic governor Janet Napolitano (now Secretary of Homeland Security), the state Chamber of Commerce, and the state hospital association. They all want to have the right to dictate to citizens how and when to buy health insurance coverage.

Now the legislature has placed a new version on the coming ballot in November. And several other states are looking to replicate it, according to John LaPlante in the St. Paul Legal Ledger. If it passes, it could set up an interesting Constitutional fight over the rights of the states versus the federal government.

SOURCE: St. Paul Legal Ledger


Michigan's Mackinac Center for Public Policy has released testimony by Michael LeFaive explaining to state legislators how they could save a ton of money by switching the state employee group to HSAs, and even more by doing the same to public school employees. He and CHCC member James Porterfield did estimates in 2007 that showed the state saving $16.2 million the first year and $1.1 billion through 2015. This was with the state paying 100 percent of premium and funding the HSAs at 100 percent.

Now they have updated this estimate and assumed 100 percent payment of premium and 75 percent of the maximum HSA contribution. They write, "Based on these and other assumptions, we estimate first-year savings of $106 million from moving state civil servants into HSAs, and cumulative savings of up to $5.9 billion through 2021."

The savings for public school employees are even higher--$451 million in the first year and $26 billion through 2121. They add, "in almost every case, employees come out ahead with patient-centered HSA plans. To cite just one of the many advantages, the maximum out-of-pocket expense is an absolute, hard number, while with traditional insurance there is no limit to some of the co-pay amounts."

Or maybe the state of Michigan can afford to throw its money away. After all, it's only the taxpayers who are affected.

SOURCE: Mackinac Center


An article in the Hartford Business Journal reports HSAs are making some headway in Connecticut. The article by Greg Bordonaro says, "As the recession and escalating costs of health care continue to plague businesses in Connecticut, enrollment in consumer-directed health plans is growing as state-based employers turn to less-costly coverage options."

It cites Aetna, where "60 percent of new business sales for small-group employers in Connecticut have been in consumer-directed health plans," and "two-thirds of middle-market employers, with 50 to 300 employees, are offering some form of consumer-directed health care as an option." It says Connecticare "is tracking similar numbers for small employers."

SOURCE: Hartford Business Journal

American Indians

The annual appropriation for IHS is approximately $2 billion.  The IHS provides health care services to approximately 1.43 million Native Americans on reservations, in rural communities and in urban areas.  In 1976, Congress enacted the IHCIA to provide "the highest possible health status to Indians and to provide existing Indian health services with all resources necessary to affect that policy."


From a PRI Study on the ranking of how good (high) or bad (low) regulations are in States:

The Top Five: New Mexico, New Hampshire, Montana, Maine, and Utah

  • New Mexico takes this category through having few restrictions on nurse practitioners’ scope of practice and the corporate practice of medicine, and no CON regulations.
  • New Hampshire, 2nd, does very well with respect to nurse practitioners and a very small share of government-owned hospitals.
  • Maine, 3rd, enjoys an idiosyncratically high showing through giving freedom to nurse practitioners and allowing the corporate practice of medicine.
  • Montana, 4th, is not outstanding in any single variable, but scores in the top half of all of them.
  • Utah, 5th, has no CON regulations and allows the corporate practice of medicine.

The Bottom Five: South Carolina, Michigan, North Carolina, New York, and West Virginia

  • South Carolina, in last place, lies well in the bottom half of all variables except the nurse practitioner–physician relationship.
  • Michigan, 49th, turns the tables on its good performance in medical tort by landing in the bottom half of all the variables in this category, except the share of hospitals owned by government.
  • North Carolina, 48th, is also well in the bottom half of all variables except the nurse practitioner–physician relationship.
  • New York, 47th, is especially burdened by overregulation of nurse practitioners and the corporate practice of medicine.
  • West Virginia, 46th, performs in the bottom half of all indicators except government ownership of hospitals and the nurse practitioner–physician relationship.