Despite Massachusetts' ability to provide nearly universal health care coverge, the state has had issues maintaining control of health care cost growth. Nonetheless, the state has passed legislation to address this matter specifically. The recent health care costs bill aims to save $200 billion over the next fifteen years.

Reform, whether mandated by the Affordable Care Act or not, is needed to address citizens' demands for quality health care services. Medicaid, state employee health care and now, health insurance exchanges are potential policy levers to increase quality, improve states' health outcomes and hold the line on costs. This session highlighted replicable initiatives undertaken by states to build an improved health care system responsive to today's fiscal policy context.

Dr. Ellen Andrews, expert speaker on the March 28 CSG health policy webinar “Value Over Volume: Paying for Quality,” urged state policymakers to be brave as they implement payment reforms that depend on the right incentives to achieve better health outcomes. She suggested to webinar attendees that the time is right for transforming delivery and payment systems–- regardless of the findings of the Supreme Court on the Affordable Care Act–-because the status quo is simply not sustainable.

Governor Beverly Perdue announced late in December that North Carolina's Medicaid program saved nearly $1 billion between 2007 and 2010 by implementing medical homes. The state-commissioned Milliman study found that North Carolina avoided spending $984 million through enrolling 1.1 million Medicaid beneficiaries in medical homes.

Montana Governor Brian Schweitzer told federal officials to expect a waiver request to set up a  universal health care system. He says the system in his state would be based on the single payer Canadian health care system that began in the province of Saskatchewan. He said in Montana the government spends $8,000 per person for health care compared to $4,000 in neighboring Saskatchewan, and that the outcomes are better in Canada.

The Columbus Dispatch reports that enough signatures were turned in by leaders of tea party groups to put a constitutional amendment on the ballot to exempt Ohio from the individual mandate of federal health reform.

One more silver bullet for reducing the seemingly inevitable rise in health care costs has been called into question.

Yesterday, Massachusetts Attorney General Martha Coakley released a study finding that the so-called “global payment” system instituted in 2009 has not saved health care costs. This payment system provides a per-patient monthly payment rather than making payments in the more traditional fee-for-service way.

Today, Vermont became the first state in the nation to establish a single-payer health care plan for the state.