State proposals to assure the child or family can see the same caregiver regardless of payment source, or at a minimum that relevant medical information about that child can be readily exchanged among caregivers, needs to be encouraged. The federal government should avoid micromanagement that interferes with effective program operation. Title XIX should be amended to allow states the flexibility to offer targeted benefits and appropriate cost sharing to uninsured or underinsured adults. The federal government should join states and communities in their efforts to reduce health disparities among population groups. Explanation Performance measurement and quality assurance activities are crucial to the success of U.S. health care programs.
States can, and do, use their purchasing power to demand improvements from the health care system.
Achieving these improvements requires realism, cooperation, and accountability on the part of purchasers, plans, and providers. Future federal policies need to emphasize not just the collection of data but support for efforts to use that data effectively to identify weaknesses, reward performance, and minimize the burden and expense of such efforts for all parties. States are also concerned about the growing number of adults who lack health insurance coverage or are underinsured. Of special concern are patterns of disparity in health status that appear to be rooted in a lack of access to care. Congress and the executive branch need to recognize, however, that some of the implementation timeframes may be unrealistic for full state compliance, since states are governed by procurement processes and legislative approvals not found in the private-industry sector.