State Health Care Reform:

Federal Requirements Influence State Reforms

T-HRD-92-55: Published: Sep 9, 1992. Publicly Released: Sep 9, 1992.

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GAO discussed its report on states' responses to the growing crisis in health care access, focusing on: (1) states' initiatives to expand accessibility and affordability of the health care system; and (2) needed changes in federal law to facilitate innovative health care reform. GAO noted that: (1) most states have focused on expanding access to health care services, such as mandating universal coverage, targeting specific uninsured groups, or creating high-risk pools for the medically uninsurable; (2) some states have also attempted to control increasing health care costs through changing the methods of reimbursing providers or reducing administrative costs; and (3) federal laws and regulations which restrict states' ability to reform health care, such as those which preempt state authority to regulate self-insured companies and make it difficult to obtain Medicaid waivers, need to be changed if states are to reform health care access effectively.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: States are no longer undertaking the types of comprehensive health care reform that would require ERISA exemptions. Additionally, Congress is considering taking an alternate approach of strengthening federal standards for employer-based health plans under ERISA rather than granting states more authority to regulate employer-based health plans.

    Matter: If Congress decides that reform at the state level is an appropriate path, it should consider reducing the potential federal barriers to comprehensive state reform.


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