Health reform yet to address the critical issue of how federal rules will impact health care delivery systems

According to a new report from State Coverage Initiatives, federal policymakers crafting health reform have yet to address the critical issue of how new or modified federal rules will impact health care delivery systems, insurance regulation, and safety net programs administered by the states.

The report, Health Care Reform and American Federalism: The Next Inter-Governmental Partnership, reviews the evolution of the nation's inter-governmental health care partnership and discusses how proposed federal reforms to expand Medicaid, create a health insurance exchange, and restructure the health care delivery system might impact that partnership.

Foremost among these questions is how the implementation of any new health reform legislation will fit with the nation's complicated and entrenched set of inter-governmental health care partnerships; and secondly, how will those rules accommodate the extraordinary inter-state (and intra-state) variation in every aspect of the nation's health care system?

"States play a key role in every aspect of our current health care system, from Medicaid and the Children's Health Insurance Program to regulating much of the nation's private health insurance industry," said Enrique Martinez-Vidal, director of the State Coverage Initiatives program. "We must consider how reforms enacted at the federal level will impact states and their varying capacities to implement those reforms."

The report includes responses from policymakers at the forefront of state health reforms, including commentary from Minnesota, New York, Rhode Island, Vermont, and Wisconsin.

Michael Sparer, the report's author, concludes, "Health reform will be administered by a complicated inter-governmental partnership, and it will be implemented in a nation in which health care systems vary significantly between and within states. Acknowledging and responding to these variables is a critical component of a successful health reform agenda."