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Examining State Efforts To Overhaul Health Care

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CQ HealthBeat on Friday examined states' efforts to overhaul their health care systems. According to CQ HealthBeat, the success of Massachusetts' health insurance law in expanding health coverage to hundreds of thousands of state residents, as well as other states' efforts to expand coverage, "shows that it is possible to find compromise on an issue that has divided the two parties for more than a decade." However, "these state efforts also show that attempts to achieve universal coverage have serious limitations," particularly around "the inability to get rising costs under control," CQ HealthBeat reports.

Approaches taken by states suggest a middle ground on health care is possible, including a combination of expanding public programs, subsidizing coverage for low-income families and businesses and focusing on cost controls, according to Alan Weil of the National Academy for State Health Policy. Massachusetts' program has implemented many concepts touted by analysts as the best way to achieve universal coverage, including an individual insurance mandate, a requirement that employers either offer health coverage for workers or pay into a state fund, and the creation of a "connector-like entity" to help individuals shop for coverage that best meets their needs and financial limitations, CQ HealthBeat reports. The number of Massachusetts residents enrolled in private or subsidized insurance policies has increased by 439,000 between June 30, 2006, when the program began, and March 31, 2008, according to an August report by state officials.

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According to CQ HealthBeat, the "Massachusetts experience ... will be key as lawmakers on Capitol Hill prepare for what is expected to be a major legislative debate next year on how to overhaul the national health care system." However, CQ HealthBeat reports that despite the successes of the law, "there are problems with the Massachusetts plan that could give federal regulators pause," including higher-than-expected costs, a shortage of primary care doctors available to treat newly insured residents and high limits on annual deductibles and out-of-pocket spending.

Efforts by lawmakers in California to overhaul the health care system "illustrate the complexity" of reaching a consensus on how to finance reform. According to Rep. Dave Camp (R-Mich.), financing is "the single greatest challenge facing health care reform, at both the state and federal levels. ... How can you create a system that finally makes health insurance available to all Americans that is financially sustainable for both the patient and the taxpayer?" The federal Employee Retirement Income Security Act also presents "[a]nother obstacle to congressional attempts to pass comprehensive health care legislation," according to CQ HealthBeat, as "some business leaders fear a federal health care overhaul effort may interfere with the law" (Carey, CQ HealthBeat, 9/26).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.