Many groups within the State Policy Network offer legislative handbooks that outline principles for sound policy. The Alabama Policy Institute is one such group. Its 2007 legislative agenda handbook (PDF) covers several policy concerns, including health.

The section on Medicaid reminds us of how pervasive that program it is. In Alabama, Medicaid enrolls nearly 39 percent of all children. It’s expected to enroll 1.2 million Alabamians by 2009, an increase of over 20 percent.

With that in mind, the Institute says that tinkering at the edges is insufficient. The handbook calls for restructuring Medicaid to account for three distinct populations: the healthy poor, people in need of long-term care, and the disabled. For the healthy poor, the report recommends giving enrolled individuals vouchers with which they can fund health savings accounts.

I'm not aware of what happened during the session in Montgomery, but I suspect that there's still a lot of room for improving the state's Medicaid system by making it more responsive to residents rather than bureaucracies.

Another goal of reform would be to change the climate for health care generally so that more people use the private sector and fewer user the public one. I'm reminded of a quip that Ronald Reagan used to say. It went something along the lines of this: "we measure success not by how many people are in government programs, but how many people leave them." With nearly 2 in 5 children in the state's health care program, success if a ways off.