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Alaska
Governor
Sarah Palin,
through
Administrative
Order 232,
has
established
the Alaska
Health Care
Strategies
Planning
Council,
which is
charged with
preparing
and
submitting a
health care
action plan
to the
Governor and
legislature
by January
1, 2008.
This plan
must include
a
description
of the
current
health care
system in
Alaska; an
inventory
and analysis
of existing
health care
plans,
reports, and
initiatives;
short-term
and
long-term
statewide
strategies
to
effectively
provide
access to
quality
health care
for
Alaskans,
while
reducing the
costs of
that care;
and
performance
measures and
accountability
mechanisms
to assess
the success
of those
strategies.
Connecticut
Governor M.
Jodi Rell
has
introduced a
health care
plan to
provide
access to
care for all
residents of
Connecticut.
The Charter
Oak Health
Plan will
create a
private-public
partnership
offering a
state-defined
benefit
package
through
private
insurers.
The proposed
plan will be
available to
adults who
do not have
insurance
through
their
workplace.
There will
be
guaranteed
issue for
the health
plan, and
premium
subsidies
will be made
available on
a sliding
scale for
lower income
individuals.
The proposed
plan
includes
reduced fees
for
preventive
care and the
assignment
to a primary
care
physician.
The target
monthly cost
for an
unsubsidized
member is
$250, plus
co-payments
and
deductibles.
The plan
will be
offered by
insurers
willing to
participate
in the plan,
and the
state will
help connect
people with
the
participating
insurers.
Governor
Rell’s
proposal
also
includes
premium
assistance
for Medicaid
patients who
already have
coverage
through an
employer.
This
assistance
would wrap
around
benefits to
provide
services
that are not
offered by
the employer
plan.
In addition,
the
governor’s
HUSKY Health
2007
initiative
targets
children who
are eligible
but not
enrolled in
the HUSKY
program. It
waives the
premium for
the first
two months
following
birth of an
eligible
child,
eliminating
any possible
reason for
not
enrolling a
newborn. The
new
initiative
also focuses
on health
coverage for
school-aged
children.
The governor
is proposing
to require
health
insurance
status
notification
at the
beginning of
every school
year and
providing
referrals to
the HUSKY
Plan for
uninsured
children.
Florida
Governor
Charlie
Crist has
proposed to
reverse some
administrative
and policy
barriers
that limited
enrollment
periods,
tightened
eligibility
standards,
increased
documentation
requirements,
and created
a complex
administrative
process that
contributed
to declining
enrollment
in the
Kidcare
program.
The governor
is
supporting
improvements
in the
structure
and
administration
of the
Kidcare
program to
provide
health care
benefits to
more
children.
The state is
proposing to
consolidate
the
fragmented
Kidcare
program
under the
Agency for
Health Care
Administration
to create a
more
efficient
and
effective
program,
which, in
combination
with a
better
outreach and
eligibility
determination
process,
will result
in more
insured
children.
Other
features of
the proposed
system
include a
simplified
and uniform
eligibility
determination
process,
uniform
benefits and
standards
between
Medicaid and
SCHIP,
presumptive
eligibility,
no caps on
private full
pay
participants,
and a
seamless
transition
between
Medicaid and
SCHIP
funding.
Georgia
Governor
Sonny Perdue
announced
the Health
Insurance
Partnership
initiative,
a new
incentive to
help
Georgia’s
small
businesses
offer
coverage for
their
employees.
Under this
plan, the
cost of
health
insurance
will be
split
between the
state
government,
employers
and
employees.
The state
will use its
bargaining
power to
work with
private
insurance
companies to
reduce costs
for small
businesses.
Business
owners will
then have
the option
of offering
their
employees
reasonably
priced
health
insurance.
The state
incentive
will be
available to
workers who
earn up to
300% of the
poverty
level. A $20
million
investment
by the
state, when
added to
inputs from
the federal
government,
the employer
and the
employee,
will amount
to a total
of $182
million in
total
investment,
which, it is
estimated,
will help
cover 30,000
people in
the first
year.
Indiana
Governor
Mitch
Daniels has
signed into
law a series
of health
reforms to
improve
access and
quality of
care in the
state.
Indiana has
created a
health
insurance
plan for
adults and
pregnant
women with
incomes
below 200
percent of
the poverty
level.
Under the
Healthy
Indiana
plan,
participating
individuals
will have a
Personal
Wellness
Responsibility
(POWER)
Account,
which acts
as an HSA,
with $1,100
to cover the
deductible.
A private
health
insurance
plan
approved by
the state is
available to
individuals
after they
have met the
deductible
and includes
services,
such as
preventive
care and
disease
management.
The plan
also
includes
$500 for
preventive
care, such
as
physicals,
screenings,
chronic
disease
management,
and smoking
cessation.
In addition,
the plan,
which passed
with
overwhelming
bipartisan
support,
includes a
44- cent
increase on
cigarettes
that is
estimated to
discourage
40,000 fewer
youth
smokers and
23,400 fewer
adult
smokers. As
a result, an
extra $11
million will
go toward
childhood
immunizations.
In addition,
the
governor’s
health care
initiative
includes
increasing
eligibility
in the SCHIP
program to
300 percent
of the
poverty
level and
providing
presumptive
eligibility
for pregnant
women. The
plan also
uses
incentives
for
employers by
providing a
small
business
qualified
wellness
program tax
credit (50
percent of
creating a
qualified
plan) and a
tax credit
for small
businesses
for the cost
of setting
up a Section
125 plan
($50 per
employee).
The law also
gives the
Family and
Social
Services
Administration
Secretary
the
authority to
develop a
program that
allows small
businesses
to purchase
group health
insurance
together.
Minnesota
Governor Tim
Pawlenty has
proposed
“Healthy
Connections,”
a health
reform plan
to increase
access to
affordable
insurance
and enhance
the quality
and value of
care.
The plan
proposes to
modernize
the
MinnesotaCare
(MNCare)
program by
reducing the
premiums for
children by
a third,
expanding
eligibility
to 300
percent of
poverty for
children,
and
increasing
subsidies in
private
coverage
rather than
the
state-provided
MNCare
program for
children
above 200
percent of
poverty. For
this option,
a standard
benefit
package,
called
MNCare II,
will be
developed by
the state
and offered
in the
private
market to
ensure basic
services are
covered and
coverage is
affordable.
The
governor’s
plan
requires
insurers
with more
than 3
percent of
individual
market to
offer the
MNCare II.
Insurers can
modify the
benefit in
order to
make it
attractive
to parents
of children
who may be
enrolled.
The
governor’s
plan creates
the
Minnesota
Health
Insurance
Exchange, a
connector
model, to
make
coverage
more
affordable
and
portable.
Employers
will be able
to use the
Exchange to
give their
employees
access to
health care
coverage,
and the
individual
market will
be folded
into the
Exchange.
The Exchange
will monitor
the products
being
offered and
ensure they
meet basic
requirements.
It will also
collect
premiums and
make the
premium
payments to
the plans,
reducing the
administrative
burden for
both
individuals
and
employers.
Employers
with more
than 10
employees
will be
responsible
for
establishing
a Section
125 plan to
ensure their
employees
can make
tax-free
deductions
of their
insurance
premiums
from their
paychecks.
To build on
Minnesota’s
current
quality of
care
programs,
the governor
proposes to
continue to
invest in
interoperable
health
systems and
to provide
transparency
of quality
and cost
data in
order for
consumers to
make
informed
decisions
about their
health
care.
In addition
to Healthy
Connections,
Governor
Pawlenty
also signed
into law an
effort to
convene a
Health Care
Transformation
Task Force
to develop a
statewide
plan to
improve
affordability,
quality,
access and
health
status of
Minnesotans.
Recommendations
to reduce
the state’s
health care
expenditures
by 20
percent will
be made by
January
2011.
Missouri
Because
Missouri’s
Medicaid
program is
sunsetting
in 2008,
Governor
Matt Blunt
is in a
unique
position to
reform the
Medicaid
program and
address the
issue of the
uninsured
simultaneously.
The proposed
redesigned
Medicaid
program,
called MO
HealthNet,
focuses on
prevention
and
wellness. MO
HealthNet
participants
will be
assigned to
a health
care home
and will
undergo a
health care
assessment
to determine
any chronic
conditions
that require
management.
In addition,
the new
Medicaid
program
stresses the
importance
of
electronic
health
information
technology.
A health
care home
coordinator
is
responsible
for
monitoring
the
patients’
conditions
and sharing
information
electronically
with the
participant.
The
governor’s
plan to
expand
coverage to
the
uninsured
also
stresses the
importance
of
prevention,
wellness,
and consumer
engagement.
The proposal
requires the
purchase of
insurance
premiums
with
tax-free
dollars
through the
use of
Section 125
plans set up
by
employers.
The plan
also allows
for
portability
of health
insurance to
allow
workers to
stay insured
when
changing
jobs. The
proposal
aims to
increase
enrollment
in the
state’s
high-risk
pool by
easing
enrollment
requirements
for the
program.
Mississippi
Last year,
Governor
Haley
Barbour
kicked off
his “Healthy
Mississippi”
initiative
to promote
disease
management
and improve
health care
at a lower
cost.
Governor
Barbour
proposed and
the
Legislature
passed the
“Mississippi
Healthy
Students
Act” this
year, which
requires 150
minutes of
physical
activity-based
instruction
per week and
45 minutes
of health
education
instruction
for K-8th
grade
students.
Additionally,
the Governor
has
partnered
with Blue
Cross Blue
Shield to
promote the
Let’s Go
Walkin’
Campaign to
get
Mississippians
active and
raise
awareness of
the benefits
of exercise.
Nearly
23,000
packets and
pedometers
have been
sent to
individuals,
churches,
schools and
businesses
in 79
counties to
serve as a
tool to
encourage
healthy
choices.
Governor
Barbour has
developed
“Healthy
Mississippi
– A Worksite
Wellness
Program” to
improve the
overall
health of
state
employees.
It is a
comprehensive
program that
will be
customized
to meet an
agency’s
specific
needs and
challenges.
The state
employee
insurance
plan
provides 100
percent
pre-deductible
coverage up
to $250 for
an annual
wellness
exam and an
additional
$50 for the
completion
of a health
risk
assessment.
In addition,
the Barbour
Administration
is
protecting
the solvency
of
Mississippi’s
Medicaid
program,
while
serving
those who
truly need
it. Medicaid
offers free
annual
physical
exams to
recipients,
checking for
diabetes and
high blood
pressure,
and to make
sure their
medications
are
accurate.
Nebraska
Due to
increasing
costs of the
state
employee
health
insurance
and
increased
expenditures
for
medications
treating
hypertension,
diabetes,
high
cholesterol
and
depression,
Governor
Dave
Heineman has
established
steering and
advisory
committees
to address
the wellness
of state
employees.
The program
made a
health
appraisal
survey
available to
state
employees
and is
addressing
the need for
improved
physical
activity,
nutrition,
and smoking
cessation.
The program
has
requested
proposals
from
organizations
to offer
tobacco
cessation
classes
under
contract for
state
employees.
The state is
also
providing
literature
outlining
the variety
of services
offered by
the Tobacco
Free
Nebraska
program to
all state
employees.
In addition,
a website is
being
developed to
provide
health
supports and
a source for
sound
medical
information
for
employees.
Rhode Island
The Rhode
Island
Office of
the Health
Insurance
Commissioner
created a
“wellness
health
benefit
plan” that
insurers are
required to
offer to
employers
with fewer
than 50
workers
purchasing
health
plans.
The insurers
will be
required to
offer a plan
that is
aimed at
improving
the health
of its
members by
focusing on
five
wellness
initiatives,
including
selecting a
primary care
physician
and
completing a
health
assessment.
In addition,
enrollees
must pledge
to maintain
a healthy
weight or
participate
in a weight
management
program,
remain
smoke-free
or
participate
in a smoking
cessation
program, and
participate
in disease
and case
management
programs, if
necessary.
It also
requires
participation
in a
wellness
program and
tiered
physician
networks.
The plan is
expected to
lower costs
based on
prevention
incentives
offered to
enrollees.
There are
Basic and
Advantage
plans with
different
cost-sharing
tiers, but
the premiums
for each
plan will be
the same.
The average
premium
cannot
exceed 10
percent of
average
wages in the
state, and
in 2007,
will be $309
or $322 per
month per
individual,
depending on
the insurer.
The wellness
health
benefit plan
will be
available in
October
2007.
South
Carolina
Governor
Mark Sanford
is proposing
health
reform
activities
to encourage
greater use
of the
private
marketplace
to provide
more
affordable
access to
health
insurance.
The governor
is planning
to establish
a separate,
standalone
CHIP program
that has a
benefit
package
modeled
after the
federal or
state
employee
benefit
plan. By
establishing
a separate
program,
more funds
will be
available to
expand
eligibility
to 200
percent of
poverty. In
addition,
the separate
SCHIP
program will
institute
monthly
premiums in
an attempt
to engage
consumers
and
encourage
personal
responsibility.
The premiums
will
discourage
those
currently in
an
employer-sponsored
plan from
dropping
their
employer
coverage to
enroll in
the SCHIP
program.
The governor
is also
proposing to
increase
access to
affordable
insurance by
allowing
small
businesses
to pool
together to
purchase
health
insurance as
a “health
group
cooperative.”
By pooling
their
employees
together,
the small
businesses
will be able
to negotiate
lower
premiums.
The proposal
also
requires a
report in
2010 to
measure the
effectiveness
of the
health group
cooperatives.
Governor
Sanford’s
reform
initiatives
also include
quality
improvement
and
measurement.
The governor
is proposing
to require
all
hospitals in
the state to
collect data
on deaths
resulting
from
hospital-acquired
infections.
The
hospitals
would be
required to
submit the
information
to the
state, which
would then
provide the
data to the
public. In
addition,
the state is
planning to
make
e-prescribing
more
seamless by
providing
standards
for the
transmission
of
electronic
prescriptions.
South Dakota
Governor
Mike Rounds
and the
South Dakota
legislature
have created
a task force
to recommend
solutions
for the
problem of
the
uninsured in
the state.
The
initiative,
called
Zaniya,
which is the
Lakota Sioux
Indian word
for “taking
care of the
health and
well being
of your
people,” is
made up of
over 50
individuals.
The task
force will
review
public
program
expansions,
private
marketplace
expansions
and changes,
and
improving
Indian
Health
Services
both on and
off the
reservations.
Texas
Governor
Rick Perry
is proposing
a premium
assistance
program to
help
low-income
uninsured
working
adults to
have access
to
affordable
health
insurance.
The state
will offer
varying
levels of
premium
assistance
based on a
sliding
scale.
Participating
plans must
be certified
by the
state. The
plans
include a
minimal
deductible
and
co-payments,
which can be
paid for by
individuals
out of an
HSA that is
set up by
the state.
Utah
Governor Jon
Huntsman has
created an
initiative
to make
health
insurance
more
affordable
by lifting
the cap
placed on
SCHIP
enrollment
due to
budgetary
constraints.
In addition,
the state is
creating the
Utah Health
Insurance
Exchange,
which will
offer
affordable
and portable
health
insurance to
residents of
the state.
Paired with
the
Exchange,
the
governor’s
plan
utilizes
Section 125
plans. The
design
allows
businesses
to be able
to offer
insurance to
their
workers
through the
Exchange and
to pay for
the premiums
tax-free.
Vermont
Governor Jim
Douglas
created a
program that
extends
affordable
insurance
coverage
while
reducing
health care
costs
through
several
quality
improvement
initiatives.
Individuals
without
access to an
employer-sponsored
insurance
plan will be
offered a
Catamount
Health plan,
which is
provided by
private
insurers and
must offer a
standard set
of benefits
defined by
the state.
Premiums
will range
from $60 per
month for
individuals
with
household
incomes
below 200
percent of
poverty, to
$135 per
month for
individuals
with
household
incomes
between 275
and 300
percent of
poverty.
In addition,
employers
are required
to pay $365
annually for
each
full-time
employee if
the employer
does not
offer
insurance,
only offers
insurance to
some
workers, or
some
employees
remain
uninsured.
This
requirement
is
applicable
to all
employers
with nine or
more
employees in
2007 and
increasing
to employers
with five or
more
employees
starting in
2010.
Low-income,
uninsured
Vermonters
with access
to an
employer-sponsored
insurance
plan will be
offered
premium
assistance.
Vermonters
eligible for
the state’s
Medicaid
program with
access to
approved
employer-sponsored
insurance
will also be
offered
premium
assistance
to
participate
in
employer-sponsored
insurance.
A chronic
care
management
system will
be created
to manage
the chronic
conditions
of
individuals
enrolled in
Medicaid and
the State
Children’s
Health
Insurance
Program, Dr.
Dynasaur.
The law also
proposes
steps to
control
costs and
cost shifts
within the
health care
system by
promoting
healthy
behaviors
through a
grant
program to
fund
community
health and
wellness
programs.
In addition,
the state
will adopt
rules to
permit
health
insurance
companies to
offer
premium
discounts or
other
incentives—known
as a Healthy
Choices
Discount— to
people who
participate
in health
promotion or
disease
prevention
programs
such as
smoking
cessation.
-###-
Molly Voris
is a Senior
Policy
Analyst in
the Health
Division of
the National
Governors
Association.
The above
snapshot is
drawn from a
July report
entitled,
“Leading the
Way: State
Health
Reform
Initiatives,”
which can be
found at
www.nga.org.
The
summaries
for GA and
MS were not
included in
the report.
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