Health Care Remains Americans’ Biggest Worry. States Can Get On The Case First.

A new Gallup poll released last month shows that the issue Americans worry about most is the availability and affordability of health care. This comes as no surprise after years of headlines covering health care issues — so core to our wellbeing and peace of mind — and the combination of political uncertainty and rising costs that keeps health care top of mind for so many of us.

Over the next few years, a number of proposals will be discussed at the federal level to improve coverage — including Medicare for All and other forms of universal coverage, options to buy in to Medicare or Medicaid, and plans to improve the Affordable Care Act. Despite the enormous energy behind finding long term solutions, however, the reality is that this Congress is unlikely to pass them, and our President is even less likely to sign them in to law. So what to do while we work to change the politics and tone in Washington? Sit on our hands?

No. The time for action is now.

Most Americans believe that every American should be covered and that that coverage should be affordable. We must turn these ideals into action. Despite dysfunction in Washington, there is another productive venue for action in the near term: namely, states. States are in a position to act right now to provide their residents with the peace of mind that comes from affordable health coverage.

This reminds me of my work at the Department of Health & Human Services during the Obama Administration, where one of my charges was to work with states that had not yet expanded Medicaid coverage to the working poor and other low-income populations.

There were a lot of politics involved, and certainly different philosophies in certain states, but even as party lines in Washington seemed to become increasingly entrenched, I saw the success of bipartisan efforts in Arkansas, Montana, Alaska, Indiana, Louisiana, and a number of other states where policymakers came together to provide health care to more of their population.

States acted then. And states can act now in a number of ways.

Over the next two legislative and ballot cycles, a number of states are looking at everything from transformational efforts to more targeted interventions, with an eye towards the twin goals of improving affordability and expanding coverage.

Some states, like Maryland, Wisconsin, and New Jersey, are considering immediate approaches to improve the private individual market by bringing more people into the risk pool and controlling premiums.

Other states are considering wholesale reforms, such as California and Washington, where advocates and lawmakers are looking at options to move to a single-payer style system.

In New Mexico and Minnesota, there are proposals to address lack of choice and control premium costs by exploring ideas that will allow people to buy into a public system like Medicaid.

In other states, more targeted policies are being considered, such as in New Jersey, where advocates are looking at closing the remaining gaps in uninsured children, or Colorado, where there is bipartisan agreement on the need to tackle mental health care, or North Carolina and Pennsylvania, which are thinking about how to increase health care access in rural communities.

States across the country and across the political spectrum are also looking at the rising price of prescription drugs and other out of pocket costs, and what levers they have to address them. Patients are already struggling with inexplicable price increases for life saving drugs like insulin, and the problem is only going to become more urgent as new breakthrough cures for previously untreatable illnesses are developed and brought to market.

We know that these ideas represent a wide range of approaches, and we believe that’s a good thing for several reasons.

First, states can enact changes that fit their needs and their practical realities, and take advantage of immediate opportunities to improve health care in ways that make sense for them. Existing proposals can also be made better and shared across states, and new ideas can be generated from what works.

Finally, a diversity of state models will provide evidence for national policymakers to evaluate when crafting major federal policy changes — something we are confident will happen as we move into the 2020s.

That’s why we at United States of Care are focusing our initial efforts on assisting states in developing, and eventually implementing, a range of policy solutions that we believe make progress in the right direction.

Passing any of these policies requires serious work — the detailed, painstaking kind that’s critical to any important success. That ranges from the multitude of decisions to fully vet a policy that will be workable at the state level and garner sufficient support to pass, to evaluating the impact on rural communities, local resources, the tax base, and care providers.

It also requires a different kind of work: understanding the hopes, needs, and concerns of people and connecting policy solutions to the problems that matter most to them.

At United States of Care we want to bring resources to state leaders in support of both these types of work — providing policy analysis and technical assistance, offering strategic advice, acting as a convener for diverse perspectives, and using polling and outreach to ensure that what people really want and need from health care in this country is reflected in policy.

Health care is a life-and-death issue, and at United States of Care, we want to get to work to make things better for people now, while we continue to build the evidence base and political will needed for change at a national level. For everyone focused on the end goal — ensuring everyone in the country has affordable care — we want to help. We look forward to being there on the front lines as it happens, and we couldn’t be more excited.