With final negotiations moving forward on Capitol Hill on a final health care reform bill, over two dozen state legislators met with the White House and Capitol Hill leaders to share views of how to build a strong state-federal partnership to provide quality, affordable health care for all Americans.
Working with the Progressive States Network and the White House Work Group of State Legislators for Health Reform, the legislators met with over thirty Congressional offices, including directly with Senators Tom Harkin, Mary Landrieu, Maria Cantwell, Max Baucus, Chuck Grassley, Amy Klobuchar, Patty Murray, the top staff of Majority Leader Harry Reid and House Speaker Nancy Pelosi, and top White House officials including David Axelrod and Nancy-Ann DeParle. (See full list of participating state legislators and Capitol Hill leaders they met with below).
The legislators shared state concerns on a wide range of issues and highlighted the need for balancing strong federal standards with promoting continued innovation by state policymakers.
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1000+ State Legislators for Health Care Reform
Part of the message that legislators brought to D.C. was the wide support by state leaders for reform. The meetings followed the announcement last week by Progressive States Network that 1,057 state legislators from all 50 states have signed letters to President Obama and Congress asking for real health reform, including a public health insurance option, strong affordability protections, and shared responsibility among individuals, employers and government for health care costs. (See here for letters and signatories in the states ).
“President Obama and Congressional leaders recognize that state legislators have been on the front lines of health care reform for decades,” said Texas Representative Garnet Coleman, co-chair of Progressive States Network. “Most proposed elements of federal reform are based on ideas already debated and in many cases enacted in the states. So state legislators know what is needed to make reform work.”
In addition to these letters showing broad-based state legislator support for reform, the National Conference of State Legislatures (NCSL) in August voted to support federal health care reform, including a public health insurance option. (See full NCSL health reform policy  and excerpts of key points ). The vote at the annual NCSL conference was overwhelming, with representatives of 38 states supporting the resolution. As Iowa State Senator Jack Hatch (D, Des Moines), who is chair of the White House Work Group and introduced the amendment at NCSL, said “We sent a very clear message to people dragging their feet in Washington: the time to act on health reform is now. We need a public health insurance option to make sure working families and small businesses are free to choose the best health care available at a price they can afford.”
State legislators and our allies have been having a tremendous impact on the D.C. health care debate. As Tom Harkin said of our work back in June during the first legislator delegation to D.C. that PSN organized , “Thank you for your tremendous leadership... This is very meaningful what you are doing here and at the White House, because I can assure you that there are powerful forces at work to keep us from having a public plan.”
View video coverage of Iowa Senator Tom Harkin, speaking at the Progressive States Network press conference on Capitol Hill by clicking on the video still below:
Progressive States Network - Over 1000 Legislators Sign Letters Supporting Federal Health Care Reform 
National Conference of State Legislators- Full Health Care Reform Policy  and Excerpts of Policy 
Statement of Purpose and Recommendations of the Legislator Delegation
State leaders highlighted broad principles that should guide reform, with an understanding of why states matter and will continue to be key players in implementing health care reform. (See here for the full Statement of Purpose  distributed to the White House and Capitol Hill leaders). Key principles included:
- Create a Floor, Not a Ceiling — As with Medicaid and SCHIP, reform ought to create necessary standards of accessibility and affordability for all states while enabling states to go further if they choose.
- Avoid Preemption — Reform should not preempt or prevent state laws that provide stronger consumer protections, coverage expansions, and industry and medical standards than what it is enacted by Congress.
- A Public Option — State legislators are committed to the necessity of a robust public option to provide more choice for Americans and businesses, and create competition in the insurance market.
- Ensure Reform is Sustainable During All Economic Conditions — The federal government must create a system of counter-cyclical funding to ensure health care for all, including an extension of the existing enhanced federal match to maintain state health programs.
- Provide All States with Necessary Financial Support — Reform must provide states with the necessary financial support to implement new programs and achieve the access, cost and quality goals of reform.
- Ensure Affordability of Coverage — The cost of health care must be limited to an affordable percentage of income for all families.
- Provide for Shared Responsibility — Government, individuals, the industry, taxpayers and businesses must all equitably participate in reform. Reform must protect the ability of states to set a higher mandate for employer responsibility than the federal floor.
- State Flexibility to Implement Reforms Early, Show Results — Reform should support states that are primed to act early on key reform provisions early in order to reinforce public support for reform and maintain public programs financed by state-only funds as states face continued deficits.
Progressive States Network had also worked with the delegation to provide an analysis of the various versions of health reform approved by committees (House committees' version, Senate HELP committee, Senate Finance committee) and how each were likely to impact the states. (See here for the full Policy and Recommendations  distributed to Capitol Hill leaders, see here). A few of the key recommendations by the delegation included:
- Medicaid Expansion: In expanding Medicaid coverage to 133% of poverty, following House language, which calls for 100% FMAP state aid for the expansion population.
- Insurance Exchange/Gateway Administration: In creating insurance "exchanges" to allow individuals and small businesses to purchase health insurance, support House language for the creation of a national exchange, with option to create a state exchange. Support HELP language, flexibility for multi-state Gateways and encourage creation of a national Gateway. Go beyond all proposals to support inclusion of small and larger businesses in option to participate in the Exchange/Gateway
- Insurance Reforms: On insurance reforms such as guaranteed issue, no pre-existing condition exclusions, no denials of coverage for pre-existing conditions, no health status or gender-based rating, support strong House and HELP language
- Affordability and the Individual Mandate: To assure premium affordability, support House language. Although the level of the hardship exemption is not clear, the cap on out of pocket costs and limit of premiums to 11% of income for those closest to 400% of poverty is strong.
- Shared Responsibility: Support House language requiring employers to cover at least 72.5% of premiums for an individual employee and 65% for family coverage.
- Public Option: Support the House language from two committees there that would foster the creation of a national public option using Medicare rates plus a 5% bonus for primary care doctors and providers.
- Financing Reform: Support House surcharge to be paid by families with incomes above $350,000 and equals, on a sliding scale, from 1% to 5.4% of modified adjusted gross income. The Finance Committee's proposed excise tax on employee health care plans is highly objectionable to workers and unions as the cost would likely get passed on to workers.
Capitol Meetings & Members of the Legislator Delegation
Over two days, legislators met with a wide range of White House and Capitol Hill leaders, including:
- Top White House officials, including David Axelrod and Nancy-Ann DeParle, as well as top staff for Majority Leader Harry Reid's and Speaker Nancy Pelosi.
- Met directly with Sen. Baucus (MT), Sen. Cantwell (WA), Sen. Grassley (IA), Sen. Harkin (IA), Sen. Kerry (MA), Sen. Klobuchar (MN), Sen. Landrieu (LA), and Sen. Murray (WA).
- Met directly with Rep. Cuellar (TX), Rep. Driehaus (OH), Rep. Edwards (TX) , Rep. Ellison (MN), Rep. Giffords (AZ), Rep. Grijalva (AZ), Rep. Inslee (WA), Rep. Kirkpatrick (AZ), Rep. Kratovil (MD), Rep. Kucinich (OH), Rep. Lynch (MA), Rep. McCollum (MN), Rep. McGovern (MA), Rep. Melancon (LA), Rep. Michaud (ME), Rep. Mitchell (AZ), Rep. Peterson (MN), Rep. Smith (WA), and Rep. Walz (MN).
- Top staff for Sen. Franken (MN), Sen. Lieberman (CT) , Sen. Snowe (ME), Rep. Walz (MN) and Rep. Peterson (MN).
Most of these reflected home state representatives of state legislators visiting DC and many are potential swing voters on federal reform who expressed appreciation at hearing about how robust health care reform could improve federal-state collaboration in improving the long-term health of Americans.
Along with PSN Executive Director Nathan Newman, the the delegation to Washington, D.C. included Sen. Luz Arce (Puerto Rico), Sen. Linda Berglin (Minnesota), Sen. Maggie Carlton (Nevada), Rep. Karen Carter Peterson (Louisiana), Rep. Garnet Coleman (Texas), Rep. Steve Conway (Washington), Rep. Steve D’Amico (Massachusetts), Del. Ana Sol Gutierrez (Maryland), Rep. Bob Hagan (Ohio), Sen. Jack Hatch (Iowa), Del. Tom Hucker (Maryland), Rep. Tom Huntley (Minnesota), Rep. Verla Insko (North Carolina), Sen. Karen Keiser (Washington), Del. Roger Manno (Maryland), Rep. Erin Murphy (Minnesota), Sen. Margarita Nolasco (Puerto Rico), Sen. Matt Rector (Guam), Rep. Elizabeth Ritter (Connecticut), Rep. Josh Shapiro (Pennsylvania), Rep. Kyrsten Sinema (Arizona), Rep. Michael Skindell (Ohio), Rep. Sharon Treat (Maine), and Sen. Jonathan Windy Boy (Montana).
Raising the Voices of the States in the Federal Debate
With Congress on the verge of passing long-awaited and potentially robust health care reform the state leaders raised the voice of state legislators to ensure that states’ needs and priorities are accounted for in the final legislation agreed to by the Congress and President Obama.