By Dan Morhaim, M.D.; Deputy Majority Leader, Maryland House of Delegates; Faculty, Johns Hopkins Bloomberg School of Public Health
Robert St. Peter hit the nail on the head in his welcoming remarks that began the conference, “The states are ground zero for health care reform.”
Several hundred health care leaders, policy analysts, and providers gathered in Washington, D.C. for the conference. They came from all over the U.S. and represented health care systems, academia, think tanks, advocacy groups, and businesses, there to listen, learn, and network.
As a state legislator, I appreciated Robert St. Peter’s emphasis. The Affordable Care Act gets a great deal of national attention, but it’s at the state level where the rubber meets the road. Think of the health care issues that states manage: implementation of ACA to be sure, but also Medicaid eligibility and enrollment, hospital regulation, health insurance, community health centers, end-of-life care, reproductive rights, medical marijuana and otherwise, professional licensing and scope of practice, medical liability and tort reform, school health programs, environmental management, recycling, tobacco and alcohol rules, and addiction programs. There’s more, but you get the idea. Yet, states often get overlooked and are under-appreciated despite their depiction as the “laboratories” of social policy.
The diversity of approach became even more evident with the first plenary panel. Representatives from Illinois, Maryland, Kentucky, and Mississippi described their state’s approach to health care. It was immediately evident that each state had its own history and culture. For example, Mississippi starts with a very low health rankings, extensive poverty, and a poor educational system. Illinois’s foremost problem is shortage of primary care providers. Kentucky moved its Medicaid eligibility level from 30 percent to 138 percent and is putting efforts into mental health reform. Maryland, despite major problems implementing its health care exchange, is working to bridge the gap between public health programs and the delivery system.
There are about 7,500 state legislators in the U.S., and about 75 are physicians. There are also nurses, social workers, and other health professionals, but not many. Most state legislatures only meet for a few months each year, meaning legislators are part-time. Only six to seven state legislatures meet year-round with full-time members. That means that state legislators are making key health care policy decisions, but often don’t have the time, expertise, or access to data to make fully informed choices. Plus, as a number of AcademyHealth presenters mentioned, the health care system is so incredibly complex that even those who work in it every day don’t understand it all.
But this also means that there’s a great opportunity to influence state policy. All of us who seek health care reform can become a great resource to the states. It’s partisan of course, but the gridlock affecting Congress is notably absent at the state level.
One more thought: I think I was the only state legislator present (except for one former legislator), and as a practicing physician and faculty member at Johns Hopkins, I kept thinking: This program is great. We need to attract and involve more state legislators. AcademyHealth has so much to offer. Let’s make the connections.