Mergers In State Health Reform: Increased Efficacy or More Bureaucracy?
Filed under: Health Reform, Obama Administration, State Initiatives
Photo by bigsurf via flickr
A health care coordination and consolidation proposal successfully made its way through the West Virginia Legislature last week and is currently awaiting the Governor’s signature. The wide-ranging reform creates a cabinet-level office to coordinate health reform across West Virginia, consolidating many existing state agencies and programs– including public hospitals and the health reform efforts of state colleges and universities. It even comes with a catchy acronym to boot– GOHELP: Governor’s Office of Health Enhancement and Lifestyle Planning.
State Delegate Don Perdue told the The Herald-Dispatch, “Health reform has been tried a number of times. It fails because one agency is not talking to another, because the vision somewhere gets lost in the process.” One might imagine Delegate Perdue to be referring to health reform in just about any state– and even the federal government. Are West Virginia legislators so far ahead of our representatives in Washington? Hopefully not. As our blog reported last week (Obama Officially Establishes White House Office of Health Reform), President Obama recently signed an executive order with an arguably similar purpose: work with several federal executive branch agencies, states and local officials, and Congress to enact health reform and develop and implement strategic initiatives to strengthen the performance of the health care system.
In Massachusetts, Governor Deval Patrick isn’t having as much luck. The Boston Globe reports of a letter the Governor wrote to the chair of the state’s Health and education Facilities Authority (HEFA) instructing the agency to merge with the state’s Development Finance Agency by July 1, 2009. The Governor’s office maintains that the merge will enhance HEFA’s ability to provide tax-exempt financing for hospitals and health facilities (as well as state educational institutions). Critics see the attempt as a “power grab” and an attack on the safeguards that keep HEFA, and other quasi-public authorities like it, safe from political pressure and “gubernatorial interference.”
Patrick isn’t alone. California Healthline noted a failed effort in the Iowa Legislature last week, which would have created a state commission to improve Iowa’s efforts to help uninsured Iowans find affordable coverage. The failure caused some back-and-forth in the state capital. State Senator Jack Hatch told The DesMoines Register that those that voted against the legislation did so “because they want to be friends with some very powerful people.” He’s referring to Wellmark Blue Cross and Blue Shield, the state’s largest private health insurer and major opponent of the legislation. Wellmark believed the commission would have added “unnecessary and expensive bureaucracy.” House Speaker Patrick Murphy rather un-artfully responded to Hatch’s statement with, “Give me a break. Jack’s full of it.”
One final note: it’s worth mentioning our Secretary of Health and Human Services-designee’s experience with merged state efforts on health reform. A few years ago, Governor Kathleen Sebelius aimed to create a cabinet-level position to tackle her ambitious health reform agenda in Kansas– much like West Virginia’s legislation above. But the Kansas Legislature wasn’t onboard. Instead, legislators gave her the Kansas Health Policy Authority. Has it been as successful as a cabinet-level post might have been? Maybe not. The Pitch: Kansas City recently highlighted Sebelius’ health reform history as Governor, and said of the Authority and its commissioners:
“Once a month, these suckers take time off from real jobs– one is a vice president at a Fortune 500 company, one is a pediatrician, others are medical-center CEOs, two are high-level university administrators, and another is a professor of management at Harvard Business School– to spend butt-numbing hours listening to endless reports on things like what to do about prescription drugs for mentally ill people, how to spend the federal stimulus money that will be coming any day now, and whether Kansas should tax its nursing homes.”
That being said, the Kansas Authority can’t be all bad. Last year, the Democratic Caucus of the state House of Representatives in neighboring Missouri ranked the creation of a Health Policy Authority (in order to “streamline bureaucracy and better coordinate health care planning”) high on its 2008 Health Policy Agenda. (You can read the full agenda here thanks to the Missouri Budget Project.) But whether Kansas Authority was a success or not, at the very least it gives Sebelius seasoned experience in what does and does not work in merged and coordinated health reform efforts. And that’s not a bad resume bullet point to bring to the Obama White House.
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