Of all the states where conservative lawmakers are trying to block the new health reform law, Georgia stands out. The Republican sponsor of a state constitutional amendment blocking the individual mandate proposed his own health reform bill three years ago, and it included an individual mandate.

We at the DLCC were shocked, just shocked to discover that there is hypocrisy in the Republican Party:

First they tried to pass a constitutional amendment in the state Senate to declare that no Georgian could be mandated by government to buy health insurance, as if Georgia law could somehow supercede federal law. The amendment failed.

(The amendment was sponsored by state Sen. Judson Hill, who three years earlier had introduced legislation that would have — wait for it — forced Georgians to buy health insurance, even giving state officials the power to garnish wages of those who refused. At the time, Hill attributed the legislation to House Speaker Newt Gingrich, who is now one of the sternest critics of “Obamacare”. In other words, mandated health insurance was a good idea until it became part of the Democratic health-reform bill, at which point it became unconstitutional and the most dire threat to American liberty since General Cornwallis surrendered at Yorktown.)

Frustrated in the Senate, Republicans then tried to pass a similar constitutional amendment in the House.

They failed. Again.

The reason the mandate is so crucial is because it makes it possible to ban exclusions for pre-existing conditions without sending premiums sky-rocketing. That’s why these Republicans thought mandates were such a brilliant idea just a few years ago.

Georgia Democrats saw right through the Republican double-talk and voted against it, preventing the proposed amendment from getting the 2/3 vote necessary to pass. That was a risky thing to do in a conservative state like Georgia, but kudos to both caucuses for standing up for health care for 32 million Americans.

The President’s reform plan hasn’t even passed yet, but right-wing state lawmakers are already trying to strip out key elements of the plan at the state level.

They’ve only managed to pass their bills in a few states like Arizona and Utah, but they’ve filed new legislation to obstruct federal health care reform in 35 states. And if reform supporters win the final showdown in Congress this week, we can expect this trend to continue.

But the stakes are just as high at the state level as they are in Congress. If Democrats fail to protect health care reform from state-level obstruction, millions of Americans who are counting on health care reform to improve -- or potentially save -- their lives will be left out in the cold:

But the $28 billion in Medicaid money is not the whole picture. These reforms will extend Medicaid coverage to nearly 8 million individuals in these states, while millions more will qualify for premium subsidies to help purchase private coverage through health insurance exchanges. This will reduce costs for employers, state governments, and insured individuals, because as these uninsured individuals and families gain coverage, the cost-shift of uncompensated care will diminish. It will also help states out because these new Medicaid eligibility levels will absorb those under 133 percent of the poverty level in state insurance programs, with full federal support for the first several years of the program.

We spend a great deal of time on this blog talking about what states are doing to reform health care. A number of states have made us proud during the last legislative session, and we expect them to continue pushing the envelope for reform, no matter what Congress decides to do.

But if we win the vote this week for health care reform, this won’t be over. The fight will just move to the state legislatures, and we predict it will be every bit as ferocious as the fight to pass the President’s health care plan in Congress.

Here at the DLCC, we’re determined to be ready.

Indiana Speaker Pat Bauer -- a DLCC Board Member -- scored a major victory this week when the state House of Representatives passed his ethics reform proposal by a vote of 97-0.

House Bill 1001 is the most comprehensive ethics plan in Indiana state history:

--The bill requires legislators to report all gifts they receive worth more than $50 — a stricter standard compared with the existing reporting threshold of $100.

--It prevents lobbyists from paying for lawmakers to travel out of Indiana and establishes a one-year "cooling off" period after legislators leave office before they can work as lobbyists.

--Lobbyists who are not lawyers will no longer be allowed to represent multiple clients who might take opposite sides of an issue, and legislative liaisons for state agencies and universities will be required to report their lobbying expenses.
The ethics bill also applies to the governor, other elected state officials and candidates running for those offices.

--Officeholders and candidates will be prohibited from raising campaign funds during odd-numbered years when the General Assembly is writing the state budget. A similar ban already applies to state legislators.

--The bill also forbids those holding statewide office from using tax dollars to pay for radio and television advertisements featuring their likenesses to promote issues and themselves.

The Senate passed HB1001 last week, and the legislation now awaits the governor's signature.

Democratic state legislators across the country made enormous progress on health care reform in 2009, and that trend is set to continue in 2010. Here are some of the state-level reform bills that made headlines this week:

• Idaho: The Idaho House and Senate -- with unanimous support from both Democratic caucuses -- have both passed HB432, a new plan to provide universal access to vaccinations for all Idaho children. Funded entirely by insurance companies and administered by a board of experts, the plan will allow vaccines to be purchased more cheaply and reduce the “free-rider” problem that creates an economic disincentive for insurance companies to cover childhood vaccinations.
  
  
• New Mexico: Democratic-sponsored HB12, which mandates that insurance companies spend at least 85% of their budgets on direct medical care, has been approved overwhelmingly and now awaits the governor’s signature.
  
  
• Ohio: The Ohio legislature has unanimously approved a three-month extension of COBRA health insurance for workers who’ve lost their jobs. The extension will allow Ohioans to take advantage of a 65% CORBA subsidy provided by the federal government for the full 15 months approved by Congress.
  
  
• Wisconsin: The Democratically-controlled Wisconsin Senate has narrowly approved the creation of a limited, state-run insurance program to provide basic coverage for uninsured adults on the waiting list for a more extensive, Medicaid-funded program. BadgerCare Plus Basic would be paid for through individual premiums of $130 per month and would not be supported by tax dollars. The bill, SB484, now moves to the Assembly.

This week, the Indiana House passed a sweeping new set of ethics reforms. The bill passed the lower chamber by a vote of 97-2 and now heads to the state senate for consideration.

Speaker Pat Bauer -- a DLCC Board Member -- introduced the legislation to reinforce public confidence in state government. If passed, the law will:

• Prohibits lawmakers from becoming lobbyists until one year after the end of their term.

• Lowers the reporting requirement threshold for gifts and meals from lobbyists to lawmakers from $100 to $50.
• Bars the governor from fundraising during a long budget session. Lawmakers already are prohibited.
• Prohibits lobbying firms from representing clients with conflicting interests.
• Bans businesses holding contracts with the state for more than $100,000 from contributing to some political campaigns.

The two members who chose to vote against the legislation were both Republicans.

Even as Congress continues to debate health care reform, state governments are stepping in to offer leadership and oftentimes expand coverage.

Last year, when Washington state was facing a $9 billion revenue shortfall, many observers expressed concerned that lawmakers would take steps to cut back on its General Assistance for the Unemployable (GA-U) program -- which offers health coverage for those with disabilities that prevent them from holding steady employment.

Instead, the legislature protected GA-U and established a pilot program to offer coordinated health care to improve the service in two counties. The results were successful, saving the state $3.5 million in hospital and pharmaceutical costs.

This year, the GA-U program will go statewide, covering 18,000 people who cannot work.

The legislature must address another shortfall next year, but reforms like this -- which save the state significant money in the long term -- offer lawmakers plenty of incentive to find ways to keep new programs funded.

Indiana State House Speaker Pat Bauer, a DLCC Board Member, has unveiled a comprehensive ethics reform package aimed at cleaning up the ethical climate in both the legislative and executive branches. The centerpiece of Speaker Bauer’s plan is a year-long waiting period for former legislators and executive appointees who want to become lobbyists:

“I think you just have to have a cleaner playing field in both perception and reality,” he said.

One proposal that has been discussed for years is a one-year cooling-off period before legislators can become lobbyists once they leave the General Assembly.

In recent years, a large number of lawmakers have left the legislature and immediately moved into the halls to lobby former colleagues.

Just by announcing his plan, Bauer has broken through the partisan rancor that engulfed Indiana politics during the state’s budget fight. The state’s Republican Governor and Senate President called Bauer’s plan “a very good initiative” and “timely,” respectively, while the Republican House leader said he was “thrilled” by the proposal. Even the staunchly-conservative Indianapolis Star editorial board called Bauer’s waiting period idea “a much-needed reform that could help break up the insider network that's pervasive in the Statehouse.”

Nevertheless, the waiting period is just one piece of Bauer’s overall plan, which also includes:

• Requiring lobbyists to report any gift to a legislator, legislative candidate or legislative employee of more than $50 – down from the current $100 – and changing the definition of what constitutes a gift.
  
  

• Prohibiting the governor or any candidate for that office from fundraising during the long budget session of the legislature. This rule already applies to the General Assembly. (…)
  
  

• Prohibiting people and businesses having contracts with state government or bidding on contracts from making political contributions to people who hold or run for state office.
  
  

• Prohibiting lobbyists or lobbying firms from representing multiple clients if there is a conflict of interest between those clients.

This month, the California legislature passed a reform measure that would limit the ability of health insurance companies to drop patients who have been diagnosed with serious illness:

The proposal, pushed by the California Medical Assn. and other advocacy groups, would allow regulators to block the rescission of coverage unless they find that a patient intentionally lied to the company about preexisting conditions.

Government officials believe that the practice -- officially known as rescission -- has allowed insurance companies to cancel coverage for thousands of California citizens and rescission has been the focus of investigation by law enforcement agencies in California

The measure has been passed by both chambers and will head to the governor after the Assembly considers a handful of changes.

Congress is facing a lot of questions right now as it builds a national health care reform plan: Should there be a robust public option? Is a strong employer mandate necessary? What additional protections should private insurance clients enjoy? What often gets overlooked is that many state-level reforms have already addressed some of these questions, providing important clues about what a national reform plan should look like.

Massachusetts’ experience with employer mandates -- designed to prevent businesses from “dumping” health coverage for employees -- is a case in point:

The Bay State’s 2006 landmark healthcare law, often seen as a model around the country, allowed businesses who chose not to cover their employees to get by with just a minimal fee. Yet even without the threat of a serious penalty, employee dumping has not been a problem, said architects of the Massachusetts plan.

Three years after the state passed its requirements, Massachusetts businesses have not canceled insurance plans at all. In fact,150,000 more residents are privately insured through their employers.

By proving that dumping can be prevented without a strong employer mandate, Massachusetts’ experience introduces flexibility for federal lawmakers. Of course, dumping is still a serious concern -- one the Massachusetts plan ultimately solved by limiting who can use the public option:

Workers whose employers helped them pay for decent insurance were disqualified from purchasing government-subsidized plans. And for low-income people who qualify but earn twice the poverty level or more, the government-subsidized insurance costs roughly the same as a typical worker’s share of an employer-subsidized private plan, providing little financial incentive for employees to seek a change.

Many would argue that such limits defeat the purpose of a public option, setting up an important choice for public option advocates to consider: should a public option be universally available, or are some restrictions acceptable in order to protect the larger economy and preserve employer-sponsored health plans?

These are not easy issues, but whatever the outcome, any federal healthcare reform bill will almost certainly be a better piece of legislation because Massachusetts and other states have led the way with groundbreaking reforms.

In New York, for years, a division of the state Senate Research Service was responsible for creating a daily "Digest of Newspaper Clippings."

Because Republicans controlled the chamber, these jobs were filled by patronage and the clips were only sent to political allies. The program cost the state about $1.92 million and most people -- even those inside the legislature -- never knew that it existed.

Now Democrats are taking a stand to eliminate the patronage jobs and update the information distribution process:

The Research Service was targeted by Democrats not long after they took power for the first time in four decades in January, with a newly-elected 32-30 seat majority. Tuesday marked the Research Service's last full day of operation, which included the clipping service as well as a core of writers and researchers who toiled in a leased office just up the street from the state Capitol.

The thing to note here is that, instead of filling the positions with loyal Democrats, the new leadership is actually updating the process to take advantage of new technology and offering the content to everyone, regardless of party affiliation:

Democrats' newly-hired Chief Information Officer Andrew Hoppin will oversee an electronic version of the service, in which a small crew will compile stories from newspapers Web sites as well as blogs and e-mail them to Senate members, both Republican and Democrat.

It's amazing how going from X-acto knives to the Internet can change things.