Rethinking this federal-state program so that it makes sense and works is one of the Governors highest priorities. The main goal of the Health Insurance and Portability Act is administrative simplification. In theory, once fully implemented, a doctor or hospital would fill out the same electronic form for private health insurance as they would for Medicaid. From a federalism standpoint the world has shifted considerably over the last five years. Essentially, the nature of mandates has changed and preemption of state authority has superceded mandates as the major problem.
Specific changes are as follows.
First, recent legislative proposals such as the Internet tax moratorium and the Senate-proposed accelerated repeal of the state credit on the estate tax, indicate that the federal government will increasingly intrude or restrict state tax sources. For well over 200 years Congress has respected the sovereign right of states to enact their own revenue systems. Recent tax initiatives in Congress are changing this critical precedent. Second, Medicaid and related programs are becoming an increasing proportion of both state and federal spending. Third, the federal government is increasingly preempting state regulatory authority when no costs are involved.