The Leaflet: Health Care Reform at the State Level

Published March 30, 2017

The debate over the possible repeal and replace the Affordable Care Act (ACA) has been front and center over the last few weeks. While a majority of Republicans agree that the ACT has been a disaster for Americans, they seem to disagree on how to fix this health care system and address the significant problems.

House Speaker Paul Ryan introduced the American Health Care Act (AHCA), which failed to gather enough support, and as a result was withdrawn from voting on the Congressional floor. In a Press Release, Heartland Executive Director Justin Haskins, says, “Now, Republicans must work together to formulate a health care reform bill that will truly empower patients with vital free-market reforms while also permanently and completely repealing Obamacare. There has never been a better opportunity for Republicans to implement pro-liberty health care policies.”

The failure of the first attempt to repeal Obamacare has frustrated many including state lawmakers which are trying to figure out how to move forward in their own states on health care reform. Even without reforms to Obamacare at the federal level individual states can still take significant steps toward implementing a more affordable and competitive health care market.

In a Research and Commentary by Heartland Policy Analyst Matthew Glans, he outlines 10 steps state legislators should take to improve the cost and availability of health care within their respective states. He argues that states should not wait for Congress and the White House to repeal Obamacare, but rather take health care reform into their own hands to improve the system and create affordable care for all residents.

One step that Glans suggests for states is to loosen unnecessary licensing standards for professions such as nurse practitioners, dental therapists, and midwives. “States across the country have begun to consider expanding their scope-of-practice laws to allow these trained midlevel providers to help fill health care shortages. States should also get rid of maintenance of certification (MOC), which has become a profit center for medical board organizations. While a certain degree of certification will always be necessary, physicians should not be required to pass through a quagmire of costly and expensive tests that may be unnecessary,” Glans says. In fact, Oklahoma provides a model for other states because it forbids the requirement of MOC as a condition.

In a Research and Commentary, Heartland’s Nathan Makla, recommends that states can improve health care availability by expanding direct primary care (DPS). He suggests states such as North Carolina should eliminate the unnecessary regulatory barriers and allow more public-sector employees to participate in the DPC system. “DPC plans address many issues currently plaguing health care providers. DPCs eliminate burdensome insurance approvals and paperwork, which typically requires a large staff to navigate. Federal requirements lock doctors into certain treatments in order to receive reimbursement, but DPC’s allow doctors to have more freedom to treat each of their patients based on their concerns and observations,” Makla says.

Other steps Glans suggests include expanding access to health savings accounts (HSAs), eliminating unnecessary state insurance benefit mandates, and encouraging price transparency. Until the White House and Congress present a new solution, it is up to the state legislators to begin taking the necessary strides toward health care reform within their individual state.   

What We’re Working On

Budget & Tax
Research & Commentary: Constitutional Limits on Spending Would Be a Positive Step for Iowa
In this Research & Commentary, Matthew Glans examines a proposed constitutional amendment that would place stringent spending limits on Iowa legislators. “Tax and expenditure limitations, such as the proposed constitutional spending limit, effectively keep more money in the pockets of families and job creators. The best TELs are those that are passed as constitutional amendments because statutory limitations are often evaded, Iowa’s proposal fits this model. A strong spending limit would force the government to more closely monitor and limit state spending, thereby properly balancing the budget while limiting the need for future tax hikes,” Glans writes.


Health Care
Research & Commentary: Tennessee Should Reject Maintenance of Certification
In this Research & Commentary, Matthew Glans examines maintenance of certification standards and how Tennessee is considering reforms to prevent medical associations from forcing doctors to take unnecessary and expensive tests to remain certified. “MOC certifications were designed with the intention of ensuring physicians are educated on the latest health research and methods, not to act as a profit center for medical board organizations,” Glans writes. “While a certain degree of certification will always be necessary, physicians should not be required to pass through a quagmire of costly and expensive tests that may be unnecessary. Oklahoma provides a model other states can follow to end this unnecessary burden on practicing physicians.”

Michigan Considers Bills to Repeal, Replace Common Core
In this article for School Reform News, Jenni White, cofounder of Restore Oklahoma Public Education, writes about companion bills that have been introduced in the Michigan House and Senate that would repeal the state’s adoption of the Common Core State Standards and replace them with the highly-regarded standards Massachusetts used during the 2008-09 school year. The bills would also grant local districts more power to implement curriculum “based upon the school district’s educational mission,” and “respect and support the ultimate right of a parent to opt his or her child out of public school, and out of any public school activity, practice, or testing that the parents finds unacceptable with no negative repercussions.” In the article, White quotes State Rep. Gary Glenn (R-Midland), who introduced the House bill, who says “the so-called Common Core standards were adopted in Michigan with no actual test results to measure their effectiveness. The test results we’ve seen since show no improvement in student performance and, in fact, indicate that Michigan’s improvement in test scores is the worst in the nation.”

Energy & Environment
Pennsylvania Approves Gas Pipeline
In this article for Environment & Climate News, managing editor H. Sterling Burnett reports on the Pennsylvania Department of Environment Protection’s decision, after a two-and-a-half year permitting and review process, to issue final permits for construction of Sunoco Logistics Partners’ Mariner East 2 pipeline. The 350-mile pipeline is designed to carry natural gas liquids, including propane and butane, at a rate of up to 345,000 barrels per day, from the Marcellus Shale play to Sunoco’s Marcus Hook storage facility in Philadelphia. “The majority of the new pipeline,” Burnett writes “will be laid along an existing right of way corridor already used by the existing Mariner East pipeline.”

From Our Free-Market Friends
James Madison Institute
Open for Business: Policy Brief
Issues with occupational licensing have risen within the state of Florida.  While advocates believe that occupational licensing improves the quality of products and services, on the other hand, the opposition feels that it presents too much of a barrier for entry into career fields.  As a result, higher unemployment and higher consumer prices have been seen. Florida has prided itself with being a very business friendly state and the rising amount of licensing requirements could be harmful to the Florida economy.