How Exactly Will Health Reform Affect the States?

Despite the renewed attention on counterterrorism, health reform promises to be the issue that will consume Washington's attention this month, as negotiators from the Senate and the House begin work on reconciling two very different pieces of legislation.

Just how different the two pieces of legislation are -- and how different their impact would be on the states -- is the focus of Timothy Jost's new article in the New England Journal of Medicine. 

Here's the key quote:

In sum, the House bill creates a new federal program implemented and enforced consistently throughout the country by a new federal agency, the Health Choices Administration (HCA), in cooperation with the states. The Senate bill takes a bifurcated approach. Primarily, it depends on the states to adopt the federal insurance reforms as their own law, establish their own exchanges, and under federal supervision but without ongoing federal financial support, implement and enforce the law themselves. But alternatively, the Senate lets the states opt out of national reform altogether, creating their own reform programs.


In truth, as Jost points out, the differences may not be as stark as they seem. Even the House version allows states to establish and run their own health exchanges. Nonetheless the differences between the two bills are striking. It will be interesting to see which vision of state-federal relations emerges after House and Senate negotiators complete their work.