States taking small steps on health system reform

Although states appear to have lost their appetites for Massachusetts-style comprehensive coverage legislation, they continue to pursue more incremental health system reforms, says a recent report by health insurers.

For example, nine states in 2008 adopted laws requiring physicians or hospitals to report infection rates, prices, or other quality and cost information. About 25 states have embraced such transparency laws in the past three years, said Susan Laudicina, author of "State Legislative Health Care and Insurance Issues," an annual survey released Feb. 20 by the BlueCross BlueShield Assn. Laudicina is the association's director of state research and policy.

Ten states in recent years have adopted legislation allowing health plans to offer wellness incentives, including Georgia and New York in 2008. This is a reversal from the past, when "offering incentives used to be banned in some states because they were considered unfair discrimination," Laudicina said.

States continue to reduce their ranks of uninsured by passing laws requiring health plans to continue offering coverage for dependent children older than 18 -- sometimes into their mid-20s or even up to age 30. In addition, 33 states have adopted legislation in the past three years to lay the groundwork for statewide interoperable data networks in anticipation of federal policy action on health information technology, she said.

Massachusetts' near-universal coverage law in 2006 spawned many pieces of copycat legislation in 2007 and 2008, but that trend has sputtered, Laudicina said. So far this year, lawmakers in only two states -- Alaska and Nebraska -- have introduced bills with employer or individual insurance mandates, she said.

Massachusetts requires most people to acquire health insurance coverage -- possibly through a state-subsidized health insurance exchange -- or face tax penalties. Employers who don't offer coverage must pay a fine.

Laudicina said Massachusetts had several advantages other states do not, such as a relatively healthy population, high rates of employer-sponsored coverage, a fund for uncompensated care and more than $700 million in federal funds available to support the effort.

Instead of adopting comprehensive coverage bills similar to the Massachusetts law, states are creating commissions to study how universal coverage could be achieved in ways that best fit. "States are not going to quit," she said.

Information on the association's report is available online (link).