STATES LOOK FOR INNOVATIVE WAYS TO EXPAND COVERAGE

Fueled by a surge in the number of Americans lacking health insurance--particularly among the middle class--state policy-makers have enacted innovative reforms to increase coverage, according to State of the States 2007: Building Hope, Raising Expectations. The report, released in January, by State Coverage Initiatives, offers a national perspective on state-based reform efforts.

The report 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 the uninsured. 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 four in five Americans that lost coverage during this time had annual incomes in excess of $50,000.

"States are facing a 'perfect storm' with health care," says 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 com promise is possible." But, he cautions, "They don't take the place of a national solution."

Despite bleak statistics about the current state of the uninsured in America, State of the States 2007 provides a measure of hope. The report found that more than a dozen states have enacted innovative polities 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).

"Several trends emerged as we analyzed this from a national perspective," Martinez-Vidal says. "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." State of the States 2007 also assesses federal reforms, which often have considerable impact on state efforts. For example, the Deficit Reduction Act of 2006 made some of the most significant changes in Medicaid'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, which is scheduled for reauthorization by Congress this year. Looking forward, State of the States 2007 predicts more state movement on the uninsured. Thirty-six new governors were elected in 2006, many with platforms that included significant goals to address the uninsured.

--The full report is available at www.statecoverage.net/pdf/stateofstates2007.pdf.

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