With the looming deadline for choosing health insurance quickly approaching, Yahoo News recently put out some enrollment figures by state. The idea was to contrast each state's projected enrollees by February 28th with the actual number of enrollees by March 1st. The numbers reveal a wide disparity between the states.

The federal government has approved a Medicare waiver for Maryland intended to reduce hospital spending, Stateline reports today. Maryland is already the only state to set uniform prices for all hospitals. The same medical procedure costs the same in every hospital in the state regardless of the insurer, including Medicare and Medicaid. This has been true since 1974.

The Medicare waiver is how Maryland can set Medicare hospital rates – otherwise it would be subject to federal rules on rates. If the waiver succeeds in holding down costs, Maryland will continue to set its own Medicare hospital rates, currently higher than those in other states.

Yesterday, new data was released by the U.S. Department of Health and Human Services that show over 3.6 million Americans have completed applications for health insurance coverage in the federal exchange and the state-based exchanges run by 14 states and the District of Columbia. 

Applicants who have made it to the finish line include nearly 365,000 who have selected a marketplace plan and 803,000 who have been determined eligible for Medicaid or CHIP (for children) coverage.

On June 20-22, 45 CSG members gathered in Washington, D.C. for the second annual Medicaid Policy Academy to learn more about Medicaid and how states can improve health outcomes for enrollees and, at the same time, run a more cost efficient program. Attendees had been nominated for attendance by health committee chairs in their home states as "rising stars" who were either new to positions of leadership on Medicaid policy or were likely to soon assume these positions.

In the world of politics, there are few simple problems and fewer simple solutions. However, some problems are more complex than others, as well as their corresponding solutions. Whether or not to build a certain bridge may invoke varying arguments for or against the project, but when the decision is made, there are a limited number of options for how to move forward. Not so with healthcare in America. There may be some tenets most Americans can agree upon but, beyond that, the solutions become more complicated. For instance, most agree that every American needs access to healthcare, in some form or fashion, but how to accomplish that is where the water gets murky. More precisely, unlike building a bridge, each answer to the problem comes with its own set of positive and negative economic and public health consequences.

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.

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