Health care reform is now a battle with numerous fronts as states, local governments, companies, and individuals across the country fight specific parts of the health care law or repeal it entirely.
- Lawsuits: Virginia’s lawsuit against ObamaCare is rocketing forward, and we could have a ruling by Thanksgiving. The suit led by Florida, which includes 18 other states and the National Federation of Independent Businesses (NFIB), faced a motion to dismiss on Sept. 14, but Federal Judge Roger Vinson will approve at least one count to go through in a finding by October 14. A number of other lawsuits have been filed in other courts with challenges to the individual mandate and federal coercion of state regulation. North Carolina has not joined any of the suits, but more individuals and companies may find reason to sue even if the state does not.
- State laws: North Carolina was among the 40+ states where legislators filed a version of the Freedom of Choice in Health Care Act. Virginia passed its bill with a Democratic Senate, and it became law before ObamaCare did. Montana followed, as did Louisiana, which passed its law through two Democratically controlled chambers. Arizona and Oklahoma have amendments to their state constitutions on the ballot November 2 to guarantee health freedom in those states. Missouri voters approved a similar ballot initiative with 71 percent of the vote.
- Public hearings: States need clarity on the provisions of ObamaCare. So while Secretary of Health and Human Services Kathleen Sebelius warns that she will have "zero tolerance" for "misinformation," state legislators and agencies in North Carolina cannot get a simple "yes or no" answer to their questions about the federal law. Few are sure exactly what the state must do to demonstrate it is keeping up with its Medicaid obligations according to federal law. Legislators and state regulators need to get answers in a public forum from the federal officials who are writing the rules.
- Medicaid waivers for now: If states comply strictly with federal rules to maintain eligibility, they can only keep the program’s growth in check by reducing payments to doctors, which will lead more doctors to refuse Medicaid patients and leave even less access to promised care. A number of states have already received waivers for innovative reforms of Medicaid in the past. California is seeking the first waiver in the ObamaCare era. One of North Carolina’s most successful local programs for mental health operates under a waiver that state lawmakers have agreed to expand statewide. Waivers are the only responsible way to keep Medicaid costs in check without hurting those who rely on the program.
- Drop Medicaid in 2014: Once federal health insurance exchanges start in 2014 with massive federal subsidies, states such as North Carolina can drop Medicaid for most populations and direct their money to long-term care for the elderly and disabled without worrying about federal rules. The state saves money and the poor get better insurance.
- Alternative accountability: States need to look at how health care professionals and paraprofessionals are held accountable. Current licensing regimes restrict access to care without improving quality. Moving to a market-based system of accountability and expanding the scope of practice for all health-care providers will reduce cost and improve access with no reduction in quality.