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Health care reform in the states

R G Frank1, M J Sullivan, P H DeLeon

  • 1Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia School of Medicine 65212.

The American Psychologist
|October 1, 1994
PubMed
Summary

State governments face rising healthcare costs and federal Medicaid expansion. Employee Retirement Income Security Act (ERISA) limits funding, prompting states to seek waivers for comprehensive health reform initiatives.

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Area of Science:

  • Health policy and economics
  • Governmental public health initiatives
  • Healthcare system reform

Background:

  • Rising healthcare expenditures challenge state governments.
  • Federal Medicaid expansion mandates broader benefits and recipient coverage.
  • Federal regulations, including the Employee Retirement Income Security Act (ERISA), limit state-level health reform efforts.

Purpose of the Study:

  • To examine the obstacles and strategies states encounter in health care system reform.
  • To analyze the impact of federal limitations on state-led health initiatives.
  • To highlight states' responses to fiscal and regulatory constraints in healthcare reform.

Main Methods:

  • Analysis of state legislative actions and policy changes.
  • Review of federal mandates and their impact on state budgets.
  • Examination of state waiver applications and their outcomes.

Main Results:

  • Eight states have successfully implemented comprehensive health reform measures.
  • Many states are actively considering legislative reforms despite federal limitations.
  • Waivers are a key strategy for states to overcome ERISA-imposed revenue restrictions.

Conclusions:

  • Federal limitations pose significant challenges to state health care reform.
  • States are actively pursuing innovative strategies, such as waivers, to navigate these challenges.
  • Despite obstacles, a trend towards comprehensive state-level health reform is evident across the nation.

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