by Dave Sterrett and Taylor Lincoln
The pathway to single-payer implementation is a winding one. Public Citizen has taken the opportunity to issue a new report that provides a road map to help navigate the process for states that seek such a system.
Efforts are moving forward in several states (Vermont, New York, California, Pennsylvania, Minnesota, Hawaii, and Colorado) to have a single government payer for health care services instead of a patchwork of private and public health insurers. Such systems (see Canada) have a record of providing comprehensive, universal care at significantly less cost than we pay for the U.S.’s fragmented system that leaves millions of people with no coverage.
But leaders in many of these state governments may be unaware of how to overcome legal obstacles to move toward a single-payer system. Today, Public Citizen released a groundbreaking report that explains the steps that states can take to create a system that would maximize the efficiencies promised by a single-payer system.
Specifically, the report addresses how a state can free itself from the strictures of the Affordable Care Act (ACA) and channel the federal money that would otherwise be spent by the federal government pursuant to the ACA into a unified, state-administered system.
To earn an ACA waiver, a state must demonstrate that its alternative would cover as many people and provide coverage at least as comprehensive as found in the ACA. But, with the goal of providing comprehensive universal care to the residents of their state, that bar is fairly easy to meet.
Beyond securing an ACA waiver, states also must overcome several other hurdles to integrate federal health care programs into their statewide single-payer system.
To the extent possible, a state needs to negotiate adjustments in the way federal programs, particularly Medicare and Medicaid, are administered in order to meld these programs with its own system. Although perfect integration would likely prove elusive, sufficient flexibility exists in federal law to permit a state to fashion a system that could appear seamless to patients and providers.
The state single-payer office would likely have to act as a behind-the-scenes traffic cop (one hopes with the help of a great deal of automation) to route bills to federal programs and other reimbursements centers while making good on payments to providers. While such a system would stop short of realizing the efficiencies of a pure single-payer system, it holds the promise of offering a system that is much more streamlined and sensible than what is currently in place.
Armed with this new report, state officials have in hand a road map to navigate the twists and turns of their important transition to a single-payer health care system.
Dave Sterrett is the health care counsel for Public Citizen’s Congress Watch division. Taylor Lincoln is research director for Public Citizen’s Congress Watch division.