How would legislators do it?

• Author: Tubbesing, Carl
• Position: Legislators give opinion on health care reform

Our 10 lawmakers know how they would craft a health-care reform plan. They say that Congress should acknowledge the states' successes and should not constrain them with an untried federal solution.

What, if state legislators were constructing it, would a final health care reform plan contain?

Flexibility.

Delaware Senator John Still summarizes the notion of flexibility this way: "There's a perception that states have flexibility in the proposal, but they really don't. The final plan should allow for diversity and accommodate differences among states. Achieving flexibility and protecting against unfunded mandates should be the two primary goals for states as the proposal moves through Congress. The plan should be changed to accommodate state reforms already in place."

Arizona Senate Minority Leader Cindy Resnick emphasizes the need for experimentation at the state level. "Why are there just two choices--managed competition and single-payer? Why not five or six? Would all states be comfortable with the managed competition approach? Arizona is a managed care state. But others have little experience with it and may like it a lot less. States have been aggressive about reform. The federal government needs to encourage experimentation," says Resnick, citing recent efforts in Florida, Washington, Hawaii, Minnesota and others.

Ohio Senator Grace Drake says simply, "I think we should let the states come up with their own solutions. You can't regulate all the states the same way. I met with Speaker Douglas Chamberlain, who's developing his own plan for Wyoming. I asked him, 'How many people live in your state?' He said, '470,000.' I have 330,000 in my Senate district. I said, 'You have more sheep than people.' You can't have an overall plan that tries to force all states into the same plan."

Representative David Richardson of Pennsylvania and Missouri Representative Chris Kelly, chair of the House Appropriations Committee, wonder why the federal government doesn't just let the states take the lead. "I think most states will adopt major reforms before the federal government will," Richardson predicts. "Why not just let the states decide what approach they want to take?"

"Why should the federal government be doing it?" Kelly asks. "We can learn from each other. Maybe Missouri will screw it up. But maybe North Carolina will get it right. Missouri could learn from North Carolina and make adjustments."

One way of providing flexibility would be for the...