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Solving the Uninsured Problem, One State at a Time

By Cheyenne Hopkins, CQ Staff

November 20, 2006 -- The federal government could learn a lesson or two from recent state initiatives that extend health care to the uninsured, but sustainable funding is still necessary to move these types of experiments forward, policy experts said at a discussion Monday.

At the forum, hosted by the Alliance for Health Reform and The Commonwealth Fund, health care experts from Massachusetts, Utah, and Vermont described recent initiatives taken in their states to extend coverage to uninsured residents.

A Massachusetts law that was signed on April 12 will require the state's 6.4 million residents—550,000 of whom are uninsured—to obtain health care coverage by July 1, 2007. The law also will subsidize premiums on a sliding scale for people earning below 300 percent of the federal poverty level.

The Vermont Legislature in May created a comprehensive health insurance plan for uninsured residents under which the state provides premium assistance to lower-income individuals to keep premiums low. Under this plan, everyone who is uninsured for 12 months will have access to—and will help pay for—a comprehensive health insurance package. The benefits will be administered through the private market and premiums will be based on income.

And in Utah, the state is using a Medicaid waiver to implement its Primary Care Network (PCN), which provides primary care and preventive services to low-income adults who otherwise would lack health insurance through increased cost-sharing for already eligible Medicaid beneficiaries.

Alice Burton, vice president of AcademyHealth, where she leads the Robert Wood Johnson Foundation's State Coverage Initiatives program, said at the discussion that states are raising hopes and expectations for solving the uninsured problem.

She outlined some trends in the state initiatives, such as the fact that comprehensive changes take time; plans often expect shared financial responsibility; expansions in coverage often rely on private insurers to deliver services; and voluntary purchasing pools, as a stand-alone strategy, are not likely to be sufficient to expand coverage.

She encouraged the federal government to enact and fund health care strategies that build on successful state plans, because not all states will be able to implement comprehensive change due to variations such as the number of uninsured in the state and the resources to address the problem. Burton said states going forward with these initiatives will be the "laboratory of democracy" for other states and the federal government, but she added that sustainable funding is essential for states to implement changes. States and the federal government need to be able to implement and fund the strategies of successful state programs, she concluded.

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