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.

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.

Nearly two years to the day after a twelve-year-old boy literally died of a toothache because of poor access to dental care, a new report by the non-partisan Pew Center on the States grades all 50 states on their success providing dental care to children. 5 of the 6 states that earned Pew’s highest grade have solidly-Democratic legislatures:

Only six states merited A grades: Connecticut, Iowa, Maryland, New Mexico, Rhode Island and South Carolina. These states met at least six of the eight policy benchmarks—that is, they had particular policies that met or exceeded the national performance thresholds. South Carolina was the nation’s top performer, meeting seven of the eight benchmarks. Although these states are doing well on these benchmarks, every state has a great deal of room to improve. No state met all eight targets.

The benchmarks measured each state on various preventive techniques, encouragement for providers to accept Medicaid patients, expanding the number and availability of dentists, and innovation in delivering care more efficiently.

Childhood dental care is often overlooked in the healthcare debate, but it’s also critically important. Early care can help prevent major (and costly) dental problems later in life, and it could have prevented the tragedy two years ago that shocked the nation.

As the Pew report states, all states have room to improve in this area, but we are deeply encouraged by the fact that the six leading states are so diverse. States from every region of the country are represented, as are states with and without large minority populations, rural states, urban states, and states at both the high and low end of the median income scale.

In fact, with the exception of South Carolina, Democratic state legislatures are about the only thing some of these states have in common.

With Congress seemingly stuck on the question of how best to advance health care reform, state lawmakers are done waiting to take up their own initiatives. One major overhaul is under consideration in California.

The bill, introduced by State Sen. Mark Leno, would -- among other things -- create a single payer system:

Christine Kehoe, a San Diego Democrat and the chairwoman of the State Senate appropriations committee, which revived Mr. Leno’s bill, said the costs to the state would be $1 million in the next fiscal year because the bill would only initially create a commission to find ways to pay for expanded health care.

And while Ms. Kehoe said a single-payer system could cost “tens of billions a year,” she added that the state was already paying significant amounts for other publicly financed health care programs. She said Mr. Leno’s bill — which would also expand eligibility for Medi-Cal, California’s Medicaid program — would eventually result in the state saving money.

“The cost of health care insurance in California is a major hindrance to our economy,” said Ms. Kehoe, citing large numbers of uninsured and people paying high rates. “If we could begin to trim some of those costs, there would be billions of dollars going into the economy for more productive use.”

California Democrats have twice before passed bills to create a single-payer system in the state, only to see them vetoed by Republican Governor Arnold Schwarzenegger.

But the importance of a single-payer win in California cannot be overstated.

Independently, California would have the 9th-largest economy in the world, and it contributes 13 percent of the United States’ gross domestic product. Adding California to the ranks of the single-payer health care systems would add enormous momentum to the national health reform push, and it would make other, more moderate reforms (like a robust public option) politically viable across the country.

So for anyone still doubting the power of state legislative politics, watch what happens if California passes this bill.

New legislation passed by Colorado lawmakers takes aim at making preventive care more affordable.

The law, which took effect Friday, assures that services such as screenings for breast and cervical cancer, cholesterol levels and colorectal cancer; childhood immunizations and flu vaccines; and programs to help manage alcohol misuse and quit smoking are available at low cost to clients, even when the insured have not met their deductibles.

Focusing on preventive care is a key component of any effort to reduce health care costs. Spotting troubling medical condition early makes them far more affordable to treat, and for Colorado, a state where cardiovascular disease are the number one killer, this type of effort holds significant potential to improve the general health of the population.

Moderate Republican State Rep. Jim Campbell has finally had it with the Maine Republican Party, led by the state’s two U.S. Senators, which has spent the better part of a year working to obstruct meaningful health care reform:

This move has been a long time coming for me. I have been very frustrated with the Republican Party in Maine, and nationally, for their failure to address the health care crisis in a meaningful way. Nobody has all the answers, but the Republican Party has none when it comes to health care reform.

This move is about the working people and our seniors who need action. I became a Republican because I believed the party stood for something. I hope to send a message to the Republican Party — and the Democratic Party — that enough is enough; it is time to stop blocking progress in the hope of partisan gain.

Rep. Campbell’s switch leaves the Maine House of Representatives with 95 Democrats, 55 Republicans and Campbell as the lone independent.

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.

State legislators don’t get to vote in Congress, but that doesn’t mean they ignore what happens there. And Washington State’s Democratic legislators have been working overtime to make sure their state’s residents get a say on health care reform and climate change legislation.

Last month, over two-thirds of Washington State’s Democratic legislators –- including State House Speaker and DLCC Board Member Frank Chopp –- signed on to a petition demanding real health care reform, with a robust public option. They followed up by sending a delegation to press their case in Washington, DC:

What a state lawmaker can hope to accomplish in pushing for national health-care reform remains to be seen. But Democratic state Sen. Karen Keiser of Kent put out word yesterday that she, Rep. Brendan Williams of Olympia and Rep. Steve Conway of Tacoma are heading back to Washington, D.C., today and Wednesday to see what they can do to help along the reforms. (…)

Keiser expects to meet today Tuesday with House and Senate leaders as well as Sen. Maria Cantwell, D-Seattle, and U.S. Rep. Adam Smith, D-Tacoma. They'll visit tomorrow Wednesday with U.S. Rep. Jay Inslee, D-Bainbridge Island, Sen. Patty Murray, D-Seattle, and White House officials.

The legislators also met with President Obama during the trip.

Now, Washington State Democrats are also pressing the case for national climate change legislation. A group of 46 State Senators and Representatives –- nearly half the Democratic caucus -- wrote to the state’s U.S. Senators to demand action:

"We need a comprehensive energy policy that sets us on a course to reduce this dependence on fossil fuels that is crippling our economy: A firm limit on global warming pollution is the policy that will do this," said the letter.

The U.S. House of Representatives narrowly passed a sweeping climate change bill last summer. The legislation is currently before the U.S. Senate, where it faces an uncertain fate.

Until legislation passes, we won’t know how effective these voices are in spurring Congressional action. But in Washington State, Democrats are determined to do everything they can.

Nine of the top-ten state healthcare systems in America are in states where Democrats control both chambers of the legislature, according to a new report by the non-partisan Commonwealth Fund.

Democratic states in the Northeast, West, and Midwest performed best of all, capturing all five of the top spots in the study:

Overall, the 2009 State Scorecard paints a picture of health care systems under stress. Still, improvements made in certain indicators and in certain areas of the U.S. indicate that individual states have the capacity to do much better, especially when their efforts are supported by strong federal policy and national initiatives. In 2009, Vermont, Hawaii, Iowa, Minnesota, Maine, and New Hampshire lead the nation as the top-ranked states (Hawaii and Iowa tied for second place; Maine and New Hampshire tied for fifth). Their performance ranks in the top quartile of states on a majority of scorecard indicators. In particular, the reforms passed by Vermont in 2006 to cover focused on preventing and controlling chronic disease are providing a new model for other states.

Especially notable about the Commonwealth Fund report is how many of the best-ranked states are pursuing healthcare reform initiatives.

Many states we’ve highlighted in the past for their innovations (including Vermont, Hawaii, and Connecticut) made the top-ten, proving once again that states (especially Democratic states) are leading the way on this important issue.

As Congress wrestles with health care reform, US Sens. Chuck Schumer (D-NY) and Tom Carper (D-DE) have offered a new proposal that would allow states to opt out of a public option if they decide the plan is not in the best interest of their citizens.

The idea might be gaining serious momentum as Democrats across the ideological spectrum indicate that they're interested in the provision.

This proposal -- and others being considered -- are notable because they would shift the initiative for health care reform from Washington into the states.

Politically, it's important to recognize that many local policymakers might be forced to make a decision about how their states should approach this issue just before the 2010 election.

But of course, in many ways, Democrats legislators have already shown that there is plenty of momentum for health care reform in our state capitols.

Already this year, lawmakers in 13 states have worked to expand insurance coverage for nearly 250,000 children, all from low-income families. Democratic legislators in Connecticut, for instance, successfully overrode a veto of substantial reform legislation from the Republican Governor Jodi Rell, even as they dealt with budget shortfalls and a host of issues.

As Time Magazine reports, states like Connecticut and Massachusetts -- which has already mandated universal health care coverage -- might be in an excellent position to push through these reforms, and perhaps more importantly:

States also may be better at innovating on delivery and payment reform, working with local health-care providers to make care more efficient and affordable.

We have a long way to go before we know what look the final bill before Congress takes (and there is still the possibility that we may see no bill at all). But if state leaders are called on take up leadership on this issue, ultimately, that's a responsibility that Democratic legislators stand ready to assume.