What’s Next? State Leadership Will Enhance National Health Reform

By Lieutenant Governor Anthony G. Brown.

Last week, President Obama signed The Patient Protection and Affordable Care Act, one of the most comprehensive and critical pieces of domestic health care legislation in over 40 years. While the challenges at the federal level to pass a bill and expand affordable access to care have been discussed in great detail, the challenges individual states will face over the next three years to implement reform have been underreported.

National health reform can only be as good as a state’s ability to implement it. With the right leadership on the state level, health reform can eclipse the original federal intent by greatly improving the quality of care for all patients and reduce health care costs.

While Republican leaders from some of our neighboring states have set a course to politicize the progress we made last week, Maryland views health reform as a tremendous opportunity to make us a stronger, healthier and more prosperous state. We’ve felt this way for some time and have taken measures on our own accord to jumpstart reform in Maryland.

During the special session Governor O’Malley called in 2007 to address the $1.7 billion structural deficit left for us by the previous administration, we passed the Working Families and Small Business Health Coverage Act. The Act created the Health Insurance Partnership, a tax credit to assist small businesses with the cost of employee’s health insurance and expanded Medicaid to 116% of the federal poverty level. Since enactment, the Act has helped 62,000 previously uninsured Marylanders obtain the coverage that they need and deserve. Last year, the state enacted first-in-the-nation legislation requiring state-regulated insurers to provide incentives for electronic health record adoption. Governor Martin O’Malley, with help from the Maryland General Assembly, is developing a statewide health information exchange – the Chesapeake Regional Information System for our Patients (CRISP) – to collect, consolidate, standardize and redistribute secure medical information. Earlier this month, the U.S. Department of Health and Human Services awarded Maryland with a $9.3 million stimulus grant to help CRISP implement our exchange.

We began this year knowing that our State’s top priority was the economy, but that health reform was a necessary component to securing our economic future. Federal reform is estimated to save Maryland $1 billion over the next ten years. As the O’Malley-Brown Administration’s point person for health issues, I have spent the past six months meeting with health experts and touring our hospitals, clinics and private practices to ask doctors, nurses, patient-advocates and administrators what policies and programs would be needed for Maryland to implement health reform by 2014. During my discussions, health professionals statewide emphasized that reform must include the expansion of information technology and Maryland’s health care workforce.

States have an incentive to develop more comprehensive health IT systems and encourage electronic health record adoption. Americans deserve the highest quality of care. More reliable and secure electronic health records will provide doctors and nurses with patients’ complete medical histories and the ability to conduct more comprehensive and efficient analyses and diagnoses. Health IT also provides hospitals and physicians with more accurate billing practices, and reduces medical errors and duplicative procedures, the combination of which reduces cost and improves the quality of patients’ care.

One of the most fundamental obstacles in states’ implementations of health reform will be to put in place the necessary workforce to meet the additional health care needs of a larger community of insured patients. In Maryland alone, more than 400,000 uninsured citizens will receive coverage due to the federal legislation and the state will need to train and employ thousands of additional nurses and physicians to meet their needs. We are leaning on our network of community colleges and undergraduate and graduate institutions to train new workers to meet the medical, clerical and IT demands of the federal legislation. To encourage more physicians to pursue employment in primary care, the O’Malley-Brown Administration has introduced legislation to establish a Maryland Patient Centered Medical Home program that places a premium on spending time with patients, emphasizes wellness and prevention, and coordinates patient’s care. This patient-centered approach has shown great promise towards improving the quality of care, reducing health costs and changing how care is delivered.

Last week, Governor O’Malley signed an Executive Order establishing the Health Reform Coordinating Council that will be responsible for coordinating existing State programs and resources with the federal reform. He’s asked me to chair the council, alongside Health and Mental Hygiene Secretary John M. Colmers. Together, we’ll address the full range of challenges presented by health reform and develop a strategic plan for implementing reform in Maryland. We will interpret the federal mandate in order to prepare for the expansion of Medicaid, reform the individual and small group markets, expand innovative pilots, establish a statewide health insurance exchange and examine how to leverage our strengths and improve weaknesses. Most importantly, we will develop a model that makes reform a reality and improves the efficiency and quality with which we provide care and reduce costs for Maryland’s taxpayers.

Health reform is long past due and President Obama’s political courage to take on such a controversial and complex issue is laudable. Still, any national effort to make transformative change must be complemented at the state level and true reform will only be as good as a state’s ability to implement it.

Maryland, for one, embraces this historic opportunity.

Anthony G. Brown is Maryland’s Lt. Governor. His policy portfolio includes the O’Malley-Brown Administration’s efforts on health care, economic development, higher education and veterans affairs. He previously served as Majority Whip in the Maryland House of Delegates while representing Prince George’s County.