States could have lots of say in how health reform plays out

Typically, most of the talk around health reform centers on the details federal legislators plan to put into their competing bills. The thing is, when all is said and done, states may have far more influence than the federal government in how health reform really plays out, analysts suggest.

States are already struggling to manage their key role under the existing health system and the administration of their Medicaid programs, and pending bills could put more on their plate. For example, all of the health exchanges called for in the Baucus bill would be run on a state-by-state level, while other reform drafts still call for a federally-run public option plan.

Other proposals by Senate moderates could allow states to establish public health plans, rather than creating one at the federal level, sidestepping the whole "federal government mounts unfair competition to the insurance industry" argument. Pushing the public option out to the states could prove a compromise that brings both Democrats and Republicans to the table, Hill watchers say.

To learn more about state reform responsibilities:
- read this Kaiser Health News piece

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