We know that where you live matters: There are huge disparities in health and costs across the country.
The uninsured rate in Texas is six times higher than in Massachusetts. You’re four times more likely to be readmitted to the hospital in Maryland or New Jersey than in Hawaii. One-third of low-income adults in Texas forgo medical care because of cost, but only 9 percent in Vermont do. Alaska spends twice as much on health care per person as Utah does.
If all states were to improve to the level of top performers, we’d see gains across the country: 20 million more people insured and 14 million fewer skipping care because of cost; 12 million more adults screened for cancer and 500,000 more children vaccinated; 124,000 fewer hospital readmissions and 90,000 fewer premature deaths.
How can we get there? Although it’s important to learn from states at the top, it’s perhaps more instructive to see what states with large improvements are doing, or have done, to get better.
Health care is perhaps the area most consistently recognized as ripe for state-based policy innovation, in keeping with the ideal of states as laboratories of democracy. Nearly all recent health reform proposals, especially from Republicans, focus on granting states greater flexibility to design and manage their health systems.
Seema Verma, the director of the Centers for Medicare and Medicaid Services, has promised to give states an “unprecedented level of flexibility” to devise their Medicaid programs, including the option to impose work requirements. Senators Lamar Alexander and Patty Murray have put forth a plan to make it easier for states to get federal waivers to reshape their health systems.
There are good reasons to pursue such a strategy. States have markedly different populations with varying needs, resources and cultures — and systems that work well in one state may not work well in another. But what do we know about how states use health policy freedom?
– The New York Times