As remarks from incoming HHS Secretary Tom Daschle clearly show, the Obama administration will probably expand government control over health-care finance and delivery through incremental steps, not a single wild leap. As the debate unfolds in Congress next year, you can expect incessant references to reforms already underway in Massachusetts, Indiana, Florida, and elsewhere. Policymakers will want to ground their proposals in recent state-level experience to reduce public apprehension and political opposition.
Obama, most Democrats, several large insurance and health-care companies, and some Republicans and conservatives will point to the Massachusetts model. It combines a government-managed supermarket for health plans, called a connector, with sliding-scale subsidies based on household income, mandates on businesses and individuals to “play or pay,” and a new state-run health plan for middle-income people to “compete” with private offerings. Their adversaries in the debate — most Republicans and conservatives, plus a few moderate-to-conservative Democrats and some parts of the health-care industry — will point to Indiana, which is using a savings-based plan to reduce the ranks of the uninsured, and Florida, which is trying to introduce consumer choice and incentives into Medicaid.
Think tankers and policy journals offer an excellent summary of each side’s assertions and arguments. Governing magazine profiles the Massachusetts and Indiana/Florida models in its December issue, with comments from a range of policy experts. The Heritage Foundation explains and champions the Massachusetts approach here. The National Center for Policy Analysis explains and champions the consumer-driven health-care approach here. Jeb Bush defends Florida’s Medicaid reforms here.