When States Lead

Suzy Khimm was guest blogging for Ezra Klein earlier this week, and she did an interesting post on how much responsibility the states will have for implementing large components of healthcare reform.  Key graf:

One of the pieces of reform that will take effect almost immediately are the high-risk pools for adults with preexisting conditions who have trouble getting insurance elsewhere. Each state has to set up a pool by July 1, or else the federal government will have to step in … The states’ willingness and ability to set up these high-risk pools by the July 1 deadline will be an early indicator of how cooperative states governments will be in putting the law into effect. Some observers are already worried that the 90-day implementation is too short and that the $5 billion devoted to the project won’t be enough to make premiums affordable, as the Journal notes. And I imagine that some reform-resistant states may be reluctant to set up these pools — and will not be particularly happy when the federal government has to intervene. At the same time, there will certainly be states eager to become model examples of how reform can work.

Sound familiar?  My impression is that statewide healthcare infrastructures aren’t dramatically more capacity-laden than state education infrastructures.  Something to think about as ESEA reauthorization gets closer to reality.  Also interesting to put the $5 billion for the enterprise across 50 states in contrast with almost that much for a selected number of RtTT states.


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