Policy Discussion:

Your state is dominated by two large health systems centered around academic medical center

Your state is in an economic downturn. Health care costs are some of the highest in the country.

Your state has an aggressive certificate of need program.

You have a small number of large employers in the state. These employers aggressively negotiate reimbursement terms with providers and tailor their own benefit plans. The cost of their benefit plans is projected to increase 5% this year.

Small employers are looking at 20% rate increases.

You have only one insurer still participating in your state exchange, and exchange premiums are projected to increase 35%

The health care provider marketplace in your state is dominated by two large systems centered around academic medical centers. They have negotiating leverage with insurers.

Many smaller community hospitals in the state have closed.

There are real disparities in care between urban and suburban populations. Women of color are 4 times as likely to die in childbirth. There is an inadequate panel of providers to service the state's Medicaid population.

Health care provider costs seem out of control, and little public data exists as to either costs or outcomes.

Malpractice insurance has become a problem for the provider community, with rates increasing 67% and a number of large jury verdicts having been won against providers.

Nationally, the Affordable Care Act is in tatters, with no alternative yet developed.

Please answer all these questions thoroughly with explanation as to why something may be. In addition, as a guide please focus on ERISA, malpractice insurance, and certificate of need programs. However, please continue to address all questions below

How would you address these issues? You can focus on one or two specific issues or think globally.

What policy initiatives should be undertaken in light of the information? What are your policy priorities? How would you go about achieving those goals? What legal and policy issues would be pertinent? Consider whether your reforms would be best addressed through private sector initiatives, through state action, by federal initiatives or through some combination of these forces. You should consider how our legal system impacts the issues you are addressing. What legislative, Constitutional and policy-making principles and practices impact the issue or issues? As always, you need to be mindful of financial considerations. How would your initiatives be funded? What are the political realities and the likely responses from vested interests?