A new survey indicates 82 percent of the leaders in health and healthcare policy believe states should be allowed to implement key provisions of the Affordable Care Act with full federal support ahead of the timeline outlined in the law.
According to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, which asked respondents about the relative authority states and the federal government should have implementing health care reform, those provisions include expanding Medicaid eligibility to cover more low-income families and creating insurance exchanges with premium subsidies.
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There are wide differences of opinion in Congress and among industry experts about the degree to which the federal government or individual states should have authority over health reform. When asked about the overall state-federal balance in the Affordable Care Act, 41 percent said the federal government should have more authority and 29 percent said the law has struck an appropriate balance between states' and the federal government's roles. Only 25 percent of respondents thought the states should have more authority.
On many healthcare reform provisions, opinion leaders were somewhat more likely to think the federal government should have a stronger role. For instance, under the law, new federal rules will prohibit insurers from restricting coverage or basing premiums on health status or gender. Half of those surveyed support granting the federal government more power to set such health insurance market rules, and 23 percent feel the law got the balance between the federal government and states about right. In addition, half favor a stronger role for the federal government in developing and spreading innovative provider payment methods, including new models like accountable care organizations and patient-centered medical homes.
A wide majority of opinion leaders expressed concerns about the barriers states face in successfully implementing the law, with 89 percent concerned or very concerned about the current fiscal situation and budgetary pressures in many states. In addition, 78 percent are concerned about state political resistance and legal challenges and 71 percent have concerns about technical knowledge and capacity of state agencies.
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"The strong support voiced by healthcare leaders for federal support of early state implementation of the Affordable Care Act indicates a vote of confidence in the benefits of the new law," said Commonwealth Fund President Karen Davis. "Leaders have also expressed concerns about barriers to implementation, such as capacity of state agencies and budget pressures, which policymakers must address to facilitate effective implementation of the law."
Other findings from the survey include:
- 61 percent support or strongly support the creation of a federal health insurance exchange, in addition to the state exchanges that will become operable in 2014.
- 49 percent support giving states the ability to design their own approaches to healthcare reform as long as they achieve the same results, while 32 percent oppose it and 18 percent neither support nor oppose.
- 42 percent think there should be more federal authority over the health insurance exchanges, while 41 percrnt want more government control over the individual mandate and 40 percent was federal authrority strengthtned on medical malpractice issues.
This most recent survey is the 25th in a series from The Commonwealth Fund and the 17th conducted in partnership with Modern Healthcare.
