IN THE STATES: The View From the Louisiana Convention Center

Our colleague Julie Barnes just posted about her health reform talk at the National Conference of State Legislators in New Orleans. Here's another view of that conference from Lisa Codisopti, senior adviser at the National Women's Law Center who we know first hand is quite knowledgeable about health policy particularly its impact on women and children. Lisa respects the efforts that states are making, but like us, believes that a comprehensive national solution is the better way to go. There's no place like the Katrina-devastated Gulf Coast, she notes, to reflect on the limits of state budgets and the harm that can befall a vulnerable state population.

A glimpse at the areas hardest hit by Katrina are a great illustration of this need. Yesterday I attended a presentation on the community health centers in the area surrounding New Orleans. These public clinics—like so many around the country—serve as a vital health safety net by providing critical health services to the uninsured. Pre-Katrina, the clinics served a population with an uninsured rate of about 20 percent; in the months following the hurricane, this rate practically doubled, putting a major strain on an already weak safety net. Louisiana is doing the best it can to rebuild the broken health care system in the area around New Orleans, but there are limits to how much one state can reasonably accomplish. Federal initiatives to expand coverage could change the picture entirely; imagine how different things could be for those impacted by Katrina if they didn't have to worry about losing their health care because they had to leave the area or find another job. Frankly, imagine if any one of us didn't have to worry about losing health care for any number of reasons that have nothing to do with a hurricane (such as widowhood, divorce, or becoming self-employed)?

When I was in New Orleans about a year and a half ago, getting a glimpse of all the fighting and politicking and NIMBYing and posturing around health care there, I'm not sure I would have said Louisiana is doing the best it can, but that was then and now is now, so I'll give them the benefit of the doubt. Either way, it proves the point. States, whether well-intentioned or fumbling, can't do it themselves. They've got a role, potentially a very large role depending on how we go about fixing insurance markets. But Washington has to lead.