State Healthcare Initiatives Focus On Expanding Coverage, Promoting Cost And Quality Transparency

Blue Cross and Blue Shield Association's annual "State of the States" report outlines key healthcare and insurance legislation in the states

February 20, 2009

WASHINGTON – During 2008, states pursued a variety of initiatives designed to advance healthcare reform, especially measures aimed at promoting access to care, and quality and cost transparency, according to the Blue Cross and Blue Shield Association's (BCBSA) State Legislative Health Care and Insurance Issues report released today.

At a briefing in Washington, D.C., Susan Laudicina, BCBSA director for state research and policy, discussed how state legislators addressed key health issues during 2008 and predicted future trends for 2009.

As the economy weakened, state revenues declined significantly and the demand for public health services escalated.  While high-profile state initiatives aimed at universal coverage did not advance amidst the economic turmoil, a number of states enacted laws to increase coverage for children and promote cost and quality transparency.

Expanding coverage

State lawmakers' proposals varied from universal coverage mandates to targeted expansions for specific groups such as uninsured children, but most efforts fell victim to budget shortfalls.  Universal coverage bills failed in California, New Mexico and Pennsylvania, and efforts to expand coverage for children were constrained by the perceived lack of state and federal funding sources.  A few states cautiously expanded their Children's Health Insurance Program (CHIP) – Colorado, Florida, Iowa, Kansas, and Minnesota.  While in New Jersey, lawmakers mandated that all children aged 18 and younger have insurance coverage.

Cost and quality transparency

Nearly half of the states debated the merits of requirements to collect and publish data on provider charges and medical outcomes.  A total of nine transparency laws were enacted during 2008.  Five states – Iowa, Louisiana, Rhode Island, Washington, and West Virginia – required health providers to disclose their hospital-based infection rates and/or medical outcomes data.

Laudicina pointed out that federal reform efforts and the new provisions in the economic stimulus bill will have a significant impact on state initiatives.  "States are relying on federal funds in the stimulus package and the CHIP Reauthorization Act to avoid deep cuts to Medicaid/CHIP and to aid them in the redesign and expansion of these public programs," she said.

"Healthcare reform continues to be a top priority for most state lawmakers, who desire to advance affordable, high-quality coverage for all Americans," said Laudicina.  "We believe everyone should have health coverage and BCBSA and the 39 independent Blue Cross and Blue Shield companies are dedicated to working with state legislatures, Congress, the administration, and other stakeholders to find workable solutions to make healthcare reform a reality."

The annual report compiles state legislative developments from a BCBSA survey of the independent Blue Cross and Blue Shield companies in every state.  The report also includes reference tables and graphs that summarize cumulative state legislation in major issue areas on a state-by-state basis.  For more information about BCBSA's comprehensive healthcare reform proposal, "The Pathway to Covering America," or to find out what Blue Cross and Blue Shield companies are doing in their states, please visit www.blueadvocacy.org.