As Employer Coverage Crumbles and the Middle Class Grumbles, State Policymakers Nationwide Enact Innovative Reforms to Expand Coverage

WASHINGTON, Jan. 17 /PRNewswire-USNewswire/ -- Fueled by a surge in the number of Americans lacking health insurance -- particularly among the middle class -- state policymakers nationwide have enacted innovative reforms to increase coverage according to State of the States 2007, Building Hope, Raising Expectations. The new report, published by State Coverage Initiatives, offers a unique national perspective on state-based reform efforts.

State of the States 2007, Building Hope, Raising Expectations details a variety of factors motivating states to address this thorny problem, including the continued rise in the number of uninsured, steep declines in employer- sponsored health insurance, improved state economies with increased state revenues, and the lack of a national solution.

The loss of coverage among the middle class is perhaps the most dramatic illustration of the growing problem of uninsurance. According to U.S. Census data, from 2002 to 2005, the number of uninsured Americans rose 7 percent to more than 46 million; among those with incomes of $50,000-$75,000, it rose 24 percent. Nearly 4 in 5 Americans that lost coverage during this time had annual incomes in excess of $50,000.

"States are facing a 'perfect storm' with health care," said State Coverage Initiatives Acting Director Enrique Martinez-Vidal, "and that has provided governors and state legislators with the political will necessary to tackle the problem. States have been fertile testing grounds for new reforms and have proven that bipartisan compromise is possible." But, he cautioned, "they don't take the place of a national solution."

Despite bleak statistics about the current state of uninsurance in America, State of the States provides a measure of hope. The report found that more than a dozen states have enacted innovative policies to expand coverage. These range from comprehensive health care reform (Massachusetts, Vermont, Maine) to public-private partnerships (Arkansas, Montana, New Mexico, Oklahoma, Rhode Island, Tennessee, Utah) and initiatives to cover all children (Illinois, Pennsylvania).

Most importantly, State of the States 2007 offers a nationwide review of the state-based health care reform movement. "Several trends emerged as we analyzed this from a national perspective," said Martinez-Vidal. "We found that many successful reforms build off prior efforts; they seek to stem the erosion of employer-sponsored insurance with a number of approaches, including shared financial responsibility. They also rely on private insurers and often include a redesign of Medicaid benefits," he said.

State of the States 2007 also assesses federal reforms, which often have considerable impact on state efforts. Medicaid, for example, is one of the most important programs for states to provide insurance. The Deficit Reduction Act of 2006 made some of the most significant changes in the program's 40-year history, many of which have implications for state programs. States are also struggling to cover projected shortfalls in the State Children's Health Insurance Program (SCHIP), which is scheduled for reauthorization by Congress in 2007.

Looking forward, State of the States 2007 found that last year's reforms fueled a trend of more state movement on the uninsured, a development that seems likely to continue. Thirty-six new governors were elected in 2006, many with platforms that included significant goals to address the uninsured. How the new Congress will approach the problem, however, remains to be seen.

According to Martinez-Vidal, "the real test will be in how these reforms perform and whether they are able to make meaningful progress to reduce the uninsured. It will take some time before we can fairly assess their impact," he said, "but in the short term, policy leaders are likely to look to these new coverage programs for guidance. It's all they have."

State Coverage Initiatives (SCI) works with states to plan, execute, and maintain health insurance expansions, as well as to improve the availability and affordability of health care coverage. SCI is a national program of The Robert Wood Johnson Foundation administered by AcademyHealth.

AcademyHealth is the professional home for health services researchers, policy analysts, and practitioners, and a leading, non-partisan resource for the best in health research and policy. AcademyHealth seeks to improve health and health care by generating new knowledge and moving knowledge into action.

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