States Out In Front Of Feds on Key Issues

When Oklahoma State Senator Angela Monson testified before Congress on March 15 on a proposed federal Patients' Bill of Rights, she threw her support behind legislation that has long languished in Washington, D.C., Monson noted that the states "have taken the lead in providing needed regulation of managed care."

Health care is but one of the policy areas where states are taking action in the absence of action at the federal level. To cite a few others, many states require employers to pay a higher minimum wage than federal law mandates, and many states have greater privacy safeguards "A lot of times [state laws] serve as models for federal policy, a place to work from. The fact that there is state policy (buys time for) Congress to find a more comprehensive plan," says Joy Wilson, a National Conference of State Legislatures health policy expert.

On the health care front, the gap between the states and the rhetoric of Washington is especially striking. For example, every state currently has some form of a Patient's Bill of Rights.

Most of the state laws provide minimal protections to patients -- for example, 48 of the 50 states forbid HMOs to restrict information that doctors can give their patients. Forty-one states require HMOs to give women direct access to a gynecologist. Forty states have appeals processes that allow patients to challenge HMO decisions on treatment.

However, seven states -- Arizona, California, Georgia, Maine, Oklahoma, Texas and Washington -- have comprehensive laws in place that, among other things, allow patients to sue HMOs for malpractice.

State policy actions are seldom a substitute for action in Washington, D.C. because the reach of state laws is often limited even within the state itself. Under the federal Employee Retirement Income Security Act (ERISA), for example, large employers are generally exempt from state managed care laws."States really do serve as laboratories for democracy. Having states really be able to demonstrate the success and problems [of a bill] allows Congress to benefit as it considers federal legislation. It really helps Congress develop the best legislation possible," said Paul Harrington, health policy director of the U.S. Senate Committee on Health, Education, Pensions and Labor.

States are also way out in front of the White House and Congress on the much-talked -about issue of prescription drug benefits for the elderly. Twenty-six states have some kind of program that helps seniors pay for often-costly medications.

Lobbying groups say state action on an issue can be a catalyst for federal debate. "At the American Association of Retired Persons (AARP) we pursue every avenue we feel is appropriate, whether that is on a national, state or local level. Ideas that might be too new for federal consideration might be ripe at a state level," Cheryl Matheis, AARP's director of state affairs, told Stateline.org.