Series: The Special Session and health policy


Practically all part-time legislatures are going to need to reconvene to address issues related to the COVID crisis.

Some of these issues will be budgetary, given the hole that is getting created in state and local budgets. Some of these will be related to simply running government, resulting from the inability to gather in a session in person as was once the case.

Some of these issues, however, will be about re-imagining the social contract we have with one another. It will be about figuring out a health care system that works in the face of a significant re-alignment of values and community.

To return to life exactly as it was pre-COVID, particularly to the same health care system befoer COVID, would be to learn absolutely nothing from this event.


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So, what will we have learned from this? What will inform our next policy discussion when it comes to health care?

Over the next few weeks, we’ll be featuring some policy ideas for legislators to review ahead of the next special session. Some will be big and bold. Some will be more modest in scope. We’ll link to them below as we publish them, but here are the topics we have teed up.


As we move into a post-COVID world, I think the states will be even more important in health reform moving forward as a result of this collective experience.

There is no national response to COVID. That is self-evident. States are acting in different ways as they see fit, based on the data, the science, and the values of the community. The range of strategies is wide.

But this isn’t new. If we look at the application of the Affordable Care Act, states have taken a range of pathways to implement the law in the ten years since it passed.

For example, 36 states have expanded Medicaid while 14 have not. In the individual market, 32 states have relied upon the federally-facilitated marketplace, while 13 states (including Washington DC) have built state models. Another 6 have built state applications on the federal platform.

It’s an indication of how varied health care is in each state. However, the application of the ACA is a symptom of state diversity, not the cause.

Each state builds its own regulatory framework for insurance, stemming out of the post-WWII of employer-based insurance coverage era. Each state has its own provider base, referral patterns and plan-provider relationships. Each state procures or provider Medicaid coverage in their own way.

Even in Medicare, a national program run by the federal government, the reality varies from state to state. Reimburesements to providers vary widely by region. Medicare Advantage penetration is different by state. Even the type of MA plan – whether it’s HMO or PPO, local provider-owned or national plans – vary widely within Medicare based on the specifics of the local market

State-level diversity in health care is the reality of the American health care system. That has been catalyzed by COVID. And, reforms to the health care systems will need to work within that reality, not against it. Solutions should be led by the states, in partnership with the federal government.

Those advocating for a federal-only solution overlook the political and market-based reality of our system, catalyzed by this crisis.

So, as legislatures and governors begin to wrap their heads around what this means for health policy in the future, hopefully the ideas shared here will help inform brainstorming, creativity, and imagination as we learn from the trauma we will all have collectively endured.