Are State Solutions Practical? Thoughts on Hurricanes and Health Reform

by Lisa Codisopti, Senior Advisor
National Women’s Law Center

This post is part of a weekly series on Women and Health Reform.

Greetings from balmy New Orleans, where I am participating in the annual meeting of the National Conference of State Legislatures (NCSL)! I'm writing this blog post from the Morial Convention Center—a site that played such an unfortunate back-drop to human misery in the days (indeed years) following the wrath of Hurricane Katrina, and which still serves as a reminder of our government's utter failure to help those who had every right to expect it.

Now, three years post-Katrina, I am attending meetings of the NCSL Health Committee, wondering if— and how—our government will help the millions of Americans who don’t have access to high-quality and affordable health care. As the Health Committee begins to develop principles for federal health care reform, we must be mindful not only of state roles in national-level health reform but also the varied approaches to reform that states have already taken to address the health care crisis on their own.

Indeed, states have been at the forefront of health reform since a federal solution has been remarkably absent. But, as I've often said, state efforts are neither big enough nor fast enough to meet the challenges of health reform. They will, for instance, inevitably hit one major roadblock—fluctuating state budgets. It is clear that we need federal action to fix our health care system.

A glimpse at the areas hardest hit by Katrina are a great illustration of this need.  Yesterday I attended a presentation on the community health centers in the area surrounding New Orleans. These public clinics—like so many around the country—serve as a vital health safety net by providing critical health services to the uninsured. Pre-Katrina, the clinics served a population with an uninsured rate of about 20 percent; in the months following the hurricane, this rate practically doubled, putting a major strain on an already weak safety net. Louisiana is doing the best it can to rebuild the broken health care system in the area around New Orleans, but there are limits to how much one state can reasonably accomplish. Federal initiatives to expand coverage could change the picture entirely; imagine how different things could be for those impacted by Katrina if they didn't have to worry about losing their health care because they had to leave the area or find another job. Frankly, imagine if any one of us didn't have to worry about losing health care for any number of reasons that have nothing to do with a hurricane (such widowhood, divorce, or becoming self-employed)?

Another Katrina victim, Mississippi, is in the midst of its own challenges - where a budget standoff between the Governor and the legislature could mean $375 million in cuts to Medicaid, the public health insurance program that is critical for low-income women. In Mississippi, more than 60 percent of nonelderly adult Medicaid recipients are women. Over half a million of the state’s poorest residents depend on the program for health coverage.

We can continue to debate whether state health reform plans like those adopted in Maine, Massachusetts, or Vermont will address the health crisis. But, from where I sit in New Orleans’ Morial Convention Center it seems like a no-brainer. As long as we have states like Louisiana and Mississippi—states with high rates of uninsurance, states with low revenues or faltering economies, states that experience major public health disasters—only a national solution will do.

Comments

[Esije Dennis,]

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[deborah bolton-plucknett]

I am a nurse of 30+ years. I have railed against the privatization of our health care system since the late '70's, early '80's. I have personally witnessed the decline in quality as well as a decline in staff numbers, preparedness and resourcefulness. I have always said you cannot treat people like a car part, each individual is unique with their own set of personal issues.

My last 12 years of working were spent as a Nurse Consultant Inspector with the Cabinet of Health and Family Service for the state of KY. I went into most levels of health care facilities and conducted inspections and complaint investigations. During that time I came to realize there are some so-called health care professional groups who charge the hospitals, etc. (it is NOT a nominal fee) to conduct pre- announced inspections, for which the facilities would put on their finest and then return to previous poor practices after the so-called inspectors left. In my opinion these groups should be a starting point for reform. They are making a huge amount of money and most states have 'deemed' certain facilities if they meet this group's requirements....it has definitely been a detriment to oversight. In closing I would like to recommend reading the 1999 Inspector General's report regarding this particular group. How much longer are we going to put up with profit-driven health care which has resulted in more people dying from medical/medication errors than are killed each year on our highways?

[deborah bolton-plucknett]

I am a nurse of 30+ years. I have railed against the privatization of our health care system since the late '70's, early '80's. I have personally witnessed the decline in quality as well as a decline in staff numbers, preparedness and resourcefulness. I have always said you cannot treat people like a car part, each individual is unique with their own set of personal issues.

My last 12 years of working were spent as a Nurse Consultant Inspector with the Cabinet of Health and Family Service for the state of KY. I went into most levels of health care facilities and conducted inspections and complaint investigations. During that time I came to realize there are some so-called health care professional groups who charge the hospitals, etc. (it is NOT a nominal fee) to conduct pre- announced inspections, for which the facilities would put on their finest and then return to previous poor practices after the so-called inspectors left. In my opinion these groups should be a starting point for reform. They are making a huge amount of money and most states have 'deemed' certain facilities if they meet this group's requirements....it has definitely been a detriment to oversight. In closing I would like to recommend reading the 1999 Inspector General's report regarding this particular group. How much longer are we going to put up with profit-driven health care which has resulted in more people dying from medical/medication errors than are killed each year on our highways?