Psychiatr News February 1, 2008
Volume 43, Number 3, page 7
© 2008 American Psychiatric Association
Political Obstacles Thwart Attempts to Expand Coverage
Rich Daly
While advocates of universal health care in some states fell short of
their legislative goal, in others they helped enact limited expansions of
health care access, often targeting uninsured children.
Several states had lofty goals for expanding health care access in 2007 but
ended up with few concrete results. The outcome ran counter to the aim of many
health reform advocates, who hoped that with Washington locked in partisan
battles, the states would lead the nation toward major changes.
California, Illinois, and Pennsylvania began the year with the goal of
broadly expanding health insurance availability, but cost concerns and a
weakening economy brought their efforts up short. Each state proposed
wide-ranging health care proposals, but none ended 2007 with bills passed.
Smaller New England states have been more successful with reform.
Massachusetts enacted a statewide health care program nearly two years ago,
which some reform advocates have seen as a model for other states.
The highest-profile effort of 2007 came in California and resulted in Gov.
Arnold Schwarzenegger (R) and Assembly Speaker Fabian Núñez (D)
agreeing on a plan to achieve near universal coverage in a state with one of
the highest rates of uninsured residents. The measure received Assembly
approval, but state Senate President Pro Tempore Don Perata (D) has expressed
concern about the cost of the plan at a time when the state faces a massive
budget shortfall (see Calif. Lawmakers Wrangle Over Insurance Mandates).
The outcome in the Senate is less certain because of the plan's $14 billion
price tag. Moreover, the threshold for passage in the Senate is high: a
two-thirds super majority is required to pass spending measures. The
provisions concerning taxes and fees to pay for the expanded coverage will be
offered as a package to California voters in November.
"Most independent analysts think that California's revenue picture is
likely to worsen by next spring, potentially complicating any proposal that
involves new spending," said Leif Wellington Haase, director of the
California Project for the New America Foundation, a nonpartisan think tank
based in Washington, D.C., at a press briefing late last year.
In Illinois, Gov. Rod Blagojevich (D) made little progress on his proposals
to pay for universal access to insurance by taxing gross business receipts and
assessing employers who do not offer coverage to their workers.
His efforts were brought to a halt by the legislature, and he faced a
lawsuit stemming from his use of executive authority to widen eligibility for
state-subsidized insurance programs.
In Pennsylvania, Gov. Edward Rendell (D) was spurred to take action because
of rising costs, including the 76 percent increase from 2000 to 2006 in the
per-family cost of insurance coverage, while wages rose only 13 percent.
"We have to do something," said Ann Torregrossa, director of
policy for the Governor's Office of Health Care Reform in Pennsylvania.
"And the governor finally realized that we can't wait for
Washington."
Rendell failed to persuade his politically divided legislature to cover the
state's 900,000 uninsured through an employer assessment. Recently, Rendell
proposed funding his plan by increasing cigarette taxes and using the surplus
in a state fund designed to help physicians pay for malpractice insurance.
David Colby, vice president of Research and Evaluation at the Robert Wood
Johnson Foundation, told policymakers at a Capitol Hill briefing last December
that state and federal advocates of health care reform need to learn the
lesson of Massachusetts' successful effort to establish a statewide program.
Many advocacy and interest groups will want different and sometimes competing
components in any such program, but the overall effort should not be
sacrificed if it cannot perfectly meet all their goals and expectations. Even
Medicare has been updated and revised to different degrees every year since it
was enacted, he noted.
State health care leaders will have another chance to enact major health
care programs in 2008 as governors in New York and Connecticut expect to
receive plans for universal health coverage from advisory groups and begin
their own legislative struggles.
While little was accomplished in states considering universal coverage
plans, more was achieved by those seeking incremental change, according to the
National Conference of State Legislatures. The conference, which tracks major
legislative accomplishments every year, noted that Maryland and Texas joined
15 states that have created programs to subsidize insurance for some
individuals and small businesses. Four other states have new laws guaranteeing
that all children receive insurance through expanded eligibility for Medicaid
and the State Children's Health Insurance Program (SCHIP). Thirteen states
added modest SCHIP expansions for children in 2007.
Continued SCHIP expansions in 2008 will depend on Congress and President
Bush resolving their major differences over funding for SCHIP. Bush twice
vetoed large SCHIP increases passed by Congress in 2007 before signing an
extension of the program through March 2009 with unchanged funding
(Psychiatric News, January 18). Democrats may attempt an earlier
renewal of the program if they are able to secure Republican cooperation in
expanding the program to cover more uninsured children.
The health care focus in 2008 is likely to shift to the presidential
campaign, where the leading candidates for the Democratic nomination have each
proposed major overhauls. 
Related Article:
-
Calif. Lawmakers Wrangle Over Insurance Mandates
- Rich Daly
Psychiatr News 2008 43: 5-34.
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