IN THE STATES: National Governors Association Workshop on Benefit Packages in Health Reform

What should be included in a health care benefit package? Balancing access to comprehensive benefits with cost is tricky business, and this dilemma is increasingly evident as many states try to cover more residents with limited access to financing.

We took this issue on the road yesterday and participated in an important discussion with state policymakers at the National Governors Association's "Defining Benefit Packages in Health Reform" meeting in Philadelphia.

There were at least three main points we took away from this conversation:

1. Financing health care must be a shared responsibility between the federal government, state government, individuals and sometimes employers, if it is to be affordable;
2. Determining the minimum set of required benefits is a value-based, community discussion that lends itself to regional differences;
3. Providing access to and incentives for preventative care is the most important goal of many state reforms.

We kicked off the program with two state officials, Susan Besio, Director of Vermont Health Care Reform Implementation and Susan Cooper, Commissioner, Tennessee Department of Health. We examined the innovative solutions to the uninsured problem in their states, as well as the lessons learned from reform proposals in Arkansas, Indiana, California and Massachusetts. The lessons from the states will serve us well in our national discussion about what services to offer, which cost-sharing solutions have the best chance of success, and how coverage can be used to improve the health care of all Americans.

For us, it was a good news-bad news meeting. The good news is that there are very creative, dedicated state policymakers who are determined to help their constituents stay healthy and lead productive lives— and are coming up with some truly ingenious solutions to do so. The bad news is that the states have extremely limited resources to accomplish a very large goal. Most policymakers peppered their comments with the adage that "it is better than nothing" in explaining why they couldn't do more than their current reform plan.

We at the New America Foundation Health Policy Program have a renewed sense of responsibility to get the states' message to national policymakers. Federal lawmakers need to pick up the health care reform ball now. They have access to the financing levers—mainly the federal tax system—necessary to cover all Americans and reform the health care delivery system to reduce costs and improve value.