Fixing health care? Learning from other states

“We passed a new law two years ago. We set rules for insurance companies and protection for consumers. For the most part it’s been working well,” the gentleman from Rhode Island shared. 

Last week officials from 34 states gathered to compare notes on health care reform. They told stories and shared details from many different health plans. The lessons I learned will help my colleagues and I grapple with one of our most difficult issues. 

 People agree on the problem. We spend twice what other counties do on health care and yet we are not as healthy. In fact, we are a sicker nation than most of the developed world.

People also agreed on many of the solutions. Fixing health care is a matter of shared benefits and shared responsibility. Government, doctors and hospitals, employers, health plans and people all have a role to play.

To gain the benefits of affordable health care and access for all, of fair payment for hospitals and doctors and affordable coverage for business, every one must share the responsibility. This includes hospitals providing affordable, quality care and sharing the cost savings from their wise decisions. It includes health plans guaranteeing access to affordable coverage and passing the savings on to business and individuals and it includes government providing the rules for a market that works.  It also includes families’ responsibility to buy affordable insurance and do their part to prevent health problems.

This is a tall order but not impossible.

I learned other states are moving faster than Wisconsin.

New Jersey recently passed phase one of a two-part public insurance plan to cover everyone. Parents are required to buy coverage for children from the public or a private plan.  Under the public plan, the insurance is quite affordable. A policy for one child is $137 a month to a maximum of $411 for multiple children. The next step is including all people in a plan.

Rhode Island created a commissioner of health insurance with consumer protection authority. A number of new rules protect consumers from unsavory insurance practices and gives state law real teeth for enforcement.

Three states have passed significant reform and are now reporting progress. Massachusetts has taken the biggest leap in requiring all people to have health coverage and make the coverage affordable through premium subsidies and substantial insurers’ rules. The uninsured numbers have been cut in half but the state needs a strong economy to continue its commitment. Budget concerns are a challenge for many states.

My time with officials from other states provided a few lessons learned:


  • Ideological views of both the left and the right have doomed health care reform. In California, despite popular support of over 70%, the legislative Republicans opposed Republican Governor Schwarzenegger’s plan from the beginning. But the plan was ultimately killed by the Democratic Chair of the Senate Health Committee who felt the plan did not go far enough.
  • The ‘status quo’ or no change was the second choice for many groups. When the ‘ideal’ proposal did not have enough support, groups settled for nothing rather than compromise.
  • In politics timing is everything. In several states health care reform was derailed when another crisis moved to center stage. Often the crisis was the budget.
  • Leadership matters. Strong plans had support from the governor and champions within the legislature. Both are important. Proposals advanced by the Governor without legislative support were often derailed by those not involved in the planning.
  • Meet, meet and meet again. Health care reform involves many groups who disagree. Keeping them talking is important, as is keeping the public informed.
  • Like all reform, health care reform is easier to stop than pass. The stories I heard were often of failure or only incremental success.

Changing one sixth of the economy is not easy. Working together is the only answer. Learning from the mistakes and successes of other states help us in Wisconsin as we plan for a new legislature in January.