The Leaflet: Health Care Reform Starts with the States

Published July 27, 2017

With a “full” Affordable Care Act repeal and a “skinny” repeal also lacking votes to pass the U.S. Senate, it is looking more and more likely the bulk of Obamacare isn’t going anywhere—at least not anytime soon.

Instead of sitting idly by as Washington, DC continues to stall and wring its hands over reforming our health care system, states should take steps to reform Medicaid and roll back other government intrusions in the health care marketplace. 

Matthew Glans, Heartland senior policy analyst, recommends: “Instead of being reactive to what’s happening in Washington, DC, state lawmakers should apply for waivers from the U.S. Department of Health and Human Services (HHS) to allow for more control over their Medicaid programs, shifting the paradigm away from health insurance and toward health care.”

While the Obama administration rejected most of the waivers submitted by states, Dr. Tom Price, secretary of HHS, has been a proponent of waivers and would likely provide states with the flexibility they need to improve their broken systems.

Glans has outlined 10 ways to improve health care at the state level, such as expanding high-risk pools for people with pre-existing conditions. As Glans explains, “Before ACA, 35 states covered these individuals through high-risk pools, state-chartered, nonprofit associations offering comprehensive health insurance through the private market.”

Other steps include eliminating unnecessary state insurance benefit mandates, expanding access to health savings accounts, rolling back certificate of need laws, and encouraging price transparency.

The Medicaid expansion provision of Obamacare decreased eligibility requirements for the program, resulting in more Medicaid recipients, which has put even more financial strain on states than expected. Lawmakers in these states can roll back and reform their Medicaid expansion, as those in Arkansas, Indiana, and Kentucky have successfully done and what lawmakers in Ohio and Oregon attempted to do this year.

Arkansas’ Medicaid rollback includes capping eligibility for those with an income 100 percent of the federal poverty level, down from 138 percent under Obamacare’s Medicaid expansion, reducing the state’s enrollment by 60,000 people.

Indiana and Kentucky have also submitted waivers to the Centers for Medicare and Medicaid Services, requesting similar work requirements for able-bodied adults without dependents to work at least 20 hours per week or to be in a job-search or training program. These work requirements mirror those crucial to the immensely successful federal welfare reforms of the 1990s, which greatly reduced national poverty rates.

A true free market in health care would lower costs for consumers by creating competition among care providers and insurance companies and allowing even the most vulnerable populations to have access to these groups.

State lawmakers should not wait on Congress to fix or roll back Obamacare. After all, Congress may never accomplish that goal. Instead, state lawmakers should move forward and implement the necessary solutions through the waiver process, rolling back unnecessary state regulations.

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