Health Care Reform in 2010: 50 States, 50 Battlegrounds

The final version of the Senate bill, with all its concessions and deals, came together the way it did because of strategy from a few key states — key states only because their Senators levied the power of their must-have votes to tweak the legislation to their own specifications. There is no reason to believe that the same won’t hold true as the House and Senate bills are merged.

Individual states are already sending signals to Congress about their opposition to the Senate bill.

New York Governor David Paterson (D) and California Governor Arnold Schwarzenegger (R) have voiced concerns that the health care reform bill passed by the Senate threatens to overload their states with added costs of Medicaid.

According to Politico.com, Gov. Paterson said “I am deeply troubled that the Senate version of the bill worsens what was already an inequitable situation for New York and I will continue to be an advocate on behalf of New Yorkers to ensure we are treated fairly by this critical federal legislation,” and Gov. Schwarzenneger wrote in a letter to House Speaker Nancy Pelosi, “When asked for my support, I was assured that federal legislation would not increase costs to California or include new unfunded mandates. Unfortunately, under nearly every scenario we can predict, the federal health care reform legislation being debated would cost California’s General Fund an additional $3 billion to $4 billion annually.”

The New York Times reports that Florida, along with about a dozen other states, is debating a proposed amendment to its state constitution that would attempt to block much of the federal government’s health care bill on the grounds that it tramples individual liberty. It should be noted that a study by the National Institute on Money in State Politics, a nonpartisan group based in Helena, Montana, shows that almost all of the 42 co-sponsors of the bill received large campaign contributions from health care interests, most heavily in the states with the proposed amendments.

Lobbyists for health care interests have taken it to the states. Last year pharmaceutical companies spent more than $20 million in political contributions in the states. $85 million more was spent on advertising to defeat a California ballot measure to lower drug prices.

As Congress works to merge the House and Senate bills, various opt-in and opt-out provisions for the regional health insurance exchanges will undoubtedly be a factor in negotiations.

In Nebraska, Senator Ben Nelson (D) was bombarded by pleas from Democrats and groups like the AFL-CIO to support health care reform and from opponents like the U.S. Chamber of Commerce and American’s Health Insurance Plans, who used webcasts and petitions to sway him to vote against reform. Television in Nebraska has been filled with arguments pro and con and hundreds of millions of dollars are being spent.

Even if a bill passes, many of the changes will not take place for several years, leaving a wide berth for state battleground strategy before the legislation can be implemented. 50 states, 50 battlegrounds. Brace yourselves. 2010 is going to be bumpy.

Combining the House and Senate Health Care Bills

Health Care Reform: Redux Ad Nauseam

Sources: Politico.com, The New York Times, Reuters

Get my updates on Twitter @AnnPietrangelo

Photo: http://www.sxc.hu/photo/1034847

Disclaimer: The views expressed above are solely those of the author and may not reflect those of
Care2, Inc., its employees or advertisers.

Past Member .

6:49AM PDT on Aug 25, 2010

Already many states are rushing to use their power to override federal mandates by voiding any requirements to buy health insurance and to void any penalties imposed by the federal government on their residents. Without the increase in policyholders estimated by congress, the premiums for health insurance with the requirements to provide insurance for preexisting conditions and eliminating lifetime caps on payouts will skyrocket and even fewer people will be able to afford insurance than before the bill came up in congress.all the predicted new healthy policyholders are a necessity for the health care bill to work and they won't be there to offset the added costs to insurance companies. Since the public option and single payer plans will be scrapped to get the bill to pass the senate, New policyholders under the final plan can expect a premium increase after the first year from the projected premium in the bill of 10% of your gross income.
This bill will only help people with money that can afford the unpredicted higher premiums.Increase Your Sales

send a green star

4:52AM PST on Jan 11, 2010

If it is up to state governments who gets access to health care and who doesn't, then this state of Kansas is going to be capricious towards those who are in the lower income brackets or receiving some kind of entitlement for disability and/or retirement. The majority party in our legislator is Republicans and conservatives, at that. I know they will pretty much set things up so that access to health care, itself, including checkups and preventative care will be denied to poor people, senior citizens, people with disabilities, and minorities. That way, they will effectively kill off those groups they consider to be "useless eaters." Actually, I would tell any one of the conservative Republicans in our state legislator that I pretty much consider conservative Republicans to be pretty worthless and useless to society themselves because they are a bunch of fascist-elitist pigs.

Paul P.

3:32AM PST on Jan 9, 2010

Here's the Mayo Clinic story referenced in my previous comment.

http://www.care2.com/news/member/714476182/1353279

3:05AM PST on Jan 9, 2010

James Carpenter - That is not what I'm saying, although it may sound like it. What I'm saying is that the type of policies proposed mimic the cost saving measures of the past. HMO's didn't save us money, PPO's didn't either, the Managed Care concept hasn't improved anything and costs more, and Medicare is working great until it doesn't, which the trustees report indicates is not that far away.

It is my opinion that the types of plans Congress and the Administration are proposing will reduce availability of care. The Mayo Clinic has been referenced by the President on many occasions as the type of provider that we need. They just announced a pilot program at their Arizona location where they will no longer be accepting Medicare. Last year, the Mayo Clinic wrote off over $800,000 in losses because Medicare reimbursement rates are below the costs of providing the care.

In other words, the actual expense to Mayo is above what Medicare will pay them. That is not sustainable, so they are considering not serving Medicare patients. If that plan is expanded or a similar one created, how many providers will become more than volunteers, actually paying for the pleasure of working?

2:53AM PST on Jan 9, 2010

IF they cannot pay let then die --- is that what some of you are saying, if it is then I feel sorry for you!

6:56AM PST on Jan 7, 2010

Roger, I don't know the current rule of thumb. What I do know is that the average private sector worker makes about $44k versus the average Federal employee at $79k. The percentage of employees above six figures is higher in Gov't than the private sector.

Here's a Cato study in 2006: www.cato.org/pubs/tbb/tbb-0605-35.pdf

And an article from the Wall Street Journal that has additional info:

http://online.wsj.com/article/SB124227027965718333.html

Richard N.

5:03AM PST on Jan 7, 2010

Thanks for sharing!

4:42PM PST on Jan 5, 2010

No matter what health care bill comes out of congress, if it still mandates that everyone must buy health care insurance or face penalties or jail it will not be accepted by the states. Already many states are rushing to use their power to override federal mandates by voiding any requirements to buy health insurance and to void any penalties imposed by the federal government on their residents. Without the increase in policyholders estimated by congress, the premiums for health insurance with the requirements to provide insurance for preexisting conditions and eliminating lifetime caps on payouts will skyrocket and even fewer people will be able to afford insurance than before the bill came up in congress.all the predicted new healthy policyholders are a necessity for the health care bill to work and they won't be there to offset the added costs to insurance companies. Since the public option and single payer plans will be scrapped to get the bill to pass the senate, New policyholders under the final plan can expect a premium increase after the first year from the projected premium in the bill of 10% of your gross income.
This bill will only help people with money that can afford the unpredicted higher premiums. This is "The Law of Unintended Consequences" that will be passed.

Jane B.

12:15PM PST on Jan 5, 2010

Dear Jeanette F,

So glad to see we're on the same page---and that you read the entire bill!

NOW what can we do to get the House bill passed?

Lauren H.

9:07PM PST on Jan 4, 2010

Continued.. My gentle giant, a 15 year old ,Maine Coon, lost his fight with cardiomyophy New Years Eve. He was sweetist
prince.