HealthCommentary

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Universal Health Care One State At a Time?

Posted on | May 20, 2008 | No Comments

Potholes in the road to universality Twelve states are currently, in one way, shape or form, pursuing universal health coverage for their citizens. When states take this on, they’re not all starting from the same point. In fact, if you take a giant broom, and sweep it west to east across the southern portion of the United States – from California to North Carolina (and including Nevada) – you’ll hit 15 states. 11 of the 15 have 18 to 24% of their populations currently without health insurance (excluding TN, AL, SC, NC). Those above the sweep have anywhere from 9 to 17% of their citizens uncovered.

If California had been successful in their bid to enact Universal Health Care for their citizens, they would have been the 5th state to do so, following Hawaii, Maine, Vermont and Massachusetts. But they became trapped in a double pincher – antitax/free marketers on the Right and single payer/ union advocates on the Left. The truth is, it’s not easy to thread the needle on this one because it is a policy road filled with obstacles.

Veteran Health Policy analysts Stephen Isaacs and Steven Schroeder recently made a pothole list. Here it is:

1. Employer Mandates – you (small business included) must cover your employees or pay a penalty (1% to 6.5% of wages in California had it passed; $295 flat fee per employee not covered in Massachusetts; $365 per employee in Vermont).

2. Individual Mandate – People not covered by an employer must purchase their own insurance (government subsidizes the payment for the poor; in California the Governor planned to cover anyone whose income was lower than 250% of the Federal Poverty level; in Massachusetts, nearly 1/5th of the population is exempted from payment.)

3. Cost – Projections killed the California bill because they would have required significant taxes or significant reallocation and/or rate adjustments of payments for services. So far the only taxes the public has been willing to support are on tobacco (the Vermont approach). Another approach – shifting of Medicaid safety net funds (controversial).

4. Cost Containment – theoretically, adjusting incentives toward health and wellness could move the dial. But, still, so many make money off of disease. It remains to be seen if you can fund the build-out of prevention on a large scale through savings earned simultaneously by decreasing the existing financial burden of chronic disease.

5. The Benefit Package –  one size rarely fits all. Age, location, values, philosophy all support a range of preferences. Potholes abound here, from financial to political to personal religous beliefs.

And then there is the election….

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