The bumpy road to health reform at the state level

The challenges of implementing national health reform at the state level took center stage at the opening plenary session of AcademyHealth's National Health Policy Conference in Washington, D.C., this morning.

It is not for the faint of heart, said Kimberly Belshe’, senior policy advisor at the Public Policy Institute of California and a member of California's five-member Health Benefit Exchange Board.

“I usually say it's not an undertaking for sissies,” she said.

Administrators from a number of states talked of the “dizzying” pace that must be maintained if state exchanges are to be up and running by the end of2013. There was talk of differing strategies while awaiting the outcome of a Supreme Court decision on the individual mandate as well as the presidential election. Most said work must continue but contingencies should be developed to deal with varying outcomes.

Belshe said a key goal is affordability, along with crucial questions of eligibility and enrollment, but added that the California exchange believes it is critical to figure how to influence better value and lower cost care. The California board is also spending much time pondering how to use its insurance purchasing clout–potentially 7 percent to 15 percent of the market in California–for the greatest good. Finally, it's important to keep consumer needs at the forefront and to seek out collaborations with a wide range of stakeholders, she said.

Charles Milligan, who administers Maryland's Medicaid program as deputy secretary for health care financing at the Maryland Department of Health and Mental Hygiene, talked about the “paradigm shift” that needs to happen to prepare the system for the changes associated with health reform. Safety net providers who had provided free care or grant-funded care will need to be ready to serve the same patients–but they will have insurance cards, he said, creating new administrative and IT requirements.

Editor's note: CHI's Deb Goeken, Michele Lueck, and Jeff Bontrager are attending AcademyHealth's National Health Policy Conference in Washington D.C. For real-time updates, follow Deb on Twitter or search #NHPC12 for updates from other attendees.

Another challenge will be creating continuity of care for people who move back and forth between Medicaid and the Exchange as their financial situations change, he said.

Milligan also used humor to describe the role of Medicaid administrators in these tough economic times. “We're really sorry about what we’ve done to your K-12 budgets and your roads,” he said.

That's a sentiment that Colorado policy makers can understand.

Deb Goeken is a vice president at CHI.