How States Can Lead Health Care Reform

Event identifies room for innovation and flexibility

Dr. Roger Stark, a policy analyst with the Washington Policy Center and retired medical doctor

On March 14, the Mackinac Center hosted an Issues and Ideas Forum on state-led health care reform with Dr. Roger Stark, a policy analyst with the Washington Policy Center and retired medical doctor.

The federal government controls the behemoth that is health care regulation through rules about Medicaid, Medicare and the Affordable Care Act. But as Stark explained, even within the vast array of laws and regulations, state have ways to experiment with new ideas, saving money and providing better care at the same time.

Stark noted that the ACA provides very little wiggle room for an administration to change the way the law is enforced, but it does have two waiver sections — one for states, and one for Medicaid.

Statewide waivers must be passed by the state Legislature, are limited in scope and must be cost-neutral. But they can allow states to provide more options by, for example, encouraging high-deductible insurance plans that come with health savings accounts. Waivers can also allow states to approve plans with more refined benefits (for example, allowing single men to purchase insurance that does not cover OB-GYN services).

But there is even more room for innovation with Medicaid waivers. Some states have instituted new rules for the program to move it back to the original goal — a social safety net. Medicaid, Stark said, “should be a bridge to individual insurance or to employer insurance.” States have tried to move toward this goal by instituting work requirements, charging premiums and limiting the amount of time people can spend in the program.

There are a number of ways Michigan could reform its laws on health care, but Stark highlighted two he felt would be most helpful. The first is to eliminate Certificate of Need laws, which artificially limit the availability of medical care and equipment. The second is to cap by law the amount of money the state is willing to spend on the expanded Medicaid program.

Making health insurance more affordable and effective is a worthy goal. It’s also a powerful one because it is tied to many other policy areas the Mackinac Center addresses, including occupational licensing, government waste and fraud and individual liberty. You can see Stark’s full talk on our website, or find out more by reading his book: “The Patient-Centered Solution: Our Health Care Crisis, How It Happened, and How We Can Fix It.”