States Keep Looking for Ways to Expand Health Care Access

December 29, 2006

The national spotlight shone on Maine’s universal health care access program when it was launched two years ago. Policymakers nationwide watched to see if Dirigo Health would deliver on its promise to provide health care coverage to Maine’s uninsured.

The spotlight has since dimmed.

These days, policymakers are more likely to be watching initiatives take shape in Massachusetts, Vermont and elsewhere that offer attempts at health care reform.

Laura Tobler, a health policy analyst with the National Conference of State Legislatures in Denver, said she has never seen so much health care reform activity bubbling on the horizon as now. She has worked on health care issues for 11 years.

While Massachusetts and Vermont have created reforms that will be implemented in 2007, other states appear poised to create reforms of their own in the year ahead, she said.

“California, Minnesota, Ohio, Wisconsin, Colorado and New Mexico are all states that have momentum this coming year,” she said. “And that’s just off the top of my head. That doesn’t mean in January there won’t be several more states with plans for comprehensive health care reform.”

Maine’s Dirigo Health Reform Act drew national attention when it was signed into law in 2003, making Maine the first state in recent years to enact legislation aimed at providing universal health care access.

The law, which went into effect Jan. 1, 2005, is designed to contain health care costs and ensure access to health care for all. When it passed in the Legislature, its goal was to insure 31,000 people in its first year and to cover all of the state’s 130,000 uninsured by 2009.

The program has fallen short of its goals — 12,153 were enrolled in the Dirigo Choice health insurance program at the end of October — and was placed under review this year by a Blue Ribbon Commission representing business, insurers, consumers, labor and the state.

This year, Massachusetts has drawn attention with legislation passed in April to reorganize its health care insurance markets and health care subsidy system. The aim is to reduce the number of uninsured covered by the government, while expanding the ranks of those who insure themselves through private programs.

The new law affects an estimated 500,000 or more people and makes Massachusetts the first state to mandate near universal health coverage for all citizens.

Vermont’s Catamount Health, passed last May, is a state-subsidized program designed to help people without insurance buy it on their own in the private marketplace. It goes into effect in October 2007.

Other states appear ready to jump on the bandwagon, said Chris Conover, a professor in the Center for Health Policy at Duke University. In particular, they look to Massachusetts’ example and wonder if it can be duplicated.

“I think there are aggressive governors who say, ‘Why can’t we do that?”‘ Conover said.

Ed Haislmaier, a research fellow at The Heritage Foundation think tank in Washington, speaks to groups nationwide about what’s going on in Massachusetts. He gets the occasional question about Maine’s Dirigo Health and other programs in New York and Maryland, but most of the interest is in Massachusetts.

States are interested in health care reform because growing health care costs are eating up state budgets, but the challenge is substantial because each state has a unique set of factors, he said.

Some states’ biggest concerns, for example, are their large numbers of immigrants, while others might have to address rural health care needs, lack of competition among hospitals or health insurance companies, or complex regulatory systems. The longer he studies the subject, the more convinced Haislmaier is that states have to customize health care reforms to their particular needs.

“We will make more progress in the next few years at state levels than on the federal level,” he said.

In Maine, the Blue Ribbon Commission began looking at Dirigo in July to explore how to cover more people, fund the program and contain costs, among other things.

Last week, the commission approved a set of recommendations that includes looking into the idea of mandated employer group coverage for workers and requirements for individuals above certain income levels to get coverage for themselves. The commission also expressed support for new taxes to expand the program.

While Democratic Gov. John Baldacci welcomed the report as a starting point for new legislation, Republican leaders called the new taxes “unacceptable” and said they have submitted their own bills to lower insurance rates.

The subject is complex and creative solutions are needed, said Sandra Featherman, chairwoman of the Blue Ribbon Commission and former president of the University of New England, the home of Maine’s only medical school.

The commission, Featherman said, looked at health care programs in Massachusetts, Vermont, Washington and Hawaii to get a sense of what else is out there.

States make good laboratories in taking stabs at health care reform, but the problem is national in scope and eventually will require a national solution, she said.

“I think whatever we do will advance the agenda a little bit,” she said.

While Maine isn’t in the spotlight now, people are still watching to see how Dirigo Health fares. That’s because there are only a few places that have taken on the issue of universal health care access, said Tobler, with the National Conference of State Legislatures.

Tobler expects more states to seek out solutions as long as the number of uninsured keeps rising and the number of employers offering health insurance benefits keeps falling.

All the while, there is no agreement at the federal level on what should be done, leaving it to the states to take it upon themselves, Tobler said.

“States have been out there as leaders in health care reform,” Tobler said. “Without a federal consensus on how to address the uninsured, states have taken on the responsibility of health care reform.”

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