States' governors use varied approaches to focus on covering the uninsured

Proposals range from an individual insurance mandate to pooling public programs.

By David Glendinning — Posted Feb. 13, 2006

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Washington -- President Bush and lawmakers in Washington are not the only ones signaling that 2006 will be a big year for tackling the issue of access to health care. Governors are making big plans of their own.

A number of the chief executives' state of the state addresses in January featured calls to action on the problems of the uninsured and underinsured. With 36 governors' seats in play in this year's elections and with 46 million or more people now without health insurance, many governors appear poised to make a big push on the access issue at the state level.

"State policy-makers are clearly feeling more on the front lines of this issue," said Alice Burton, vice president at the Washington, D.C., research group AcademyHealth. "For the first time in a couple of years, as they emerge from the budget crisis they've been in for a while, [they are] beginning to think about strategies to address the problem of the uninsured and do it in varying ways."

The following are just a few of the states whose governors have set their sights on coverage gaps in the health care system.

Kansas, New Mexico: Help for kids

One of the first steps needed to address the problem of the uninsured involves making sure that the very youngest citizens have access to care, Democratic Kansas Gov. Kathleen Sebelius said in her Jan. 9 address.

"Good health is important to every Kansan, but it's especially important for children in the first few years of life," she said. "An illness then can set back a child's development for years."

To this end, Sebelius is proposing that the state approve measures before the end of the year that would cover every Kansas child from birth to age 5. The move is aimed at the roughly 15,000 children in the state without health coverage, she said.

New Mexico's Democratic Gov. Bill Richardson has an identical coverage goal for the more than 20,000 children in his state who have no health insurance.

"This is unacceptable, and no one in this room should tolerate it, which is why we should work toward the goal of insuring all kids under 5 years old," he said in his Jan. 17 address.

To help pay for the expansions, Richardson and Sebelius are using their leadership positions on the Democratic Governors Assn. to lobby Congress this year for more than $10 billion in additional State Children's Health Insurance Program funding. But lawmakers last year approved billions in reductions to Medicaid, potentially making new SCHIP dollars difficult to procure.

Massachusetts: A market-based plan

Republican Gov. Mitt Romney will not seek re-election this year, leaving his post for what many predict will be a White House bid in 2008. But before he departs, he hopes to put his signature on a sweeping plan to cover the half-million people in Massachusetts with no health insurance.

"The stage is set for something truly historic," Romney said in his Jan. 18 state of the commonwealth address. "We are poised to provide private, market-based health insurance to all our uninsured citizens."

The plan would pair an individual insurance mandate with state-backed insurance products and penalties on employers who don't offer coverage. While the legislative proposal has been in motion for more than a year, Romney used the address to promise $200 million in state funding in an effort to get the measure passed.

The Massachusetts Medical Society has endorsed the pending legislation but warns that payments to physicians must be increased in tandem with the individual and employer mandates. "Without physicians available to meet the needs of all Massachusetts citizens, health access will be impossible," said Alan M. Harvey, MD, the society's president.

Wisconsin: Overhauling the safety net

A major restructuring of the health safety net also could be in the cards for Wisconsin. Democratic Gov. Jim Doyle hopes to use efficiencies of scale to cover more citizens and provide better care to those who already have insurance.

"This new effort -- BadgerCare Plus -- will merge 500,000 individuals currently enrolled in Medicaid, BadgerCare and Healthy Start into one streamlined and comprehensive program," Doyle said in his Jan. 17 state of the state address.

One of the goals of the proposed overhaul is to provide access to care for every Wisconsin child by next year, more than 90,000 of whom are now without insurance coverage, he said. With increased coverage rates will come increased expectations of cost sharing from higher-income families.

The Wisconsin Medical Society has not yet weighed in on the new coverage proposal.

But the group recently accused Doyle of endangering patient access by vetoing a bill that would have restored noneconomic damage caps in medical liability cases.

"We're very concerned that the absence of caps will harm Wisconsin's historically stable medical liability environment," said Susan Turney, MD, the society's executive vice president and CEO. "Wisconsin must reach an agreement that best serves both the patients of our state and the health care system."

Virginia: A new player in the field

Health care access is already on the mind of recently inaugurated Democratic Gov. Tim Kaine, who gave his first address to the Virginia joint assembly on Jan. 16. With Medicaid consuming an increasing amount of state funding every year, he called for significant changes to the program

"We must reform our Medicaid program to ensure its viability," he said. "But those reforms must come through innovation, new ways of thinking and rooting out inefficiencies -- not by rationing health care and services to the most vulnerable."

Kaine said an inefficient patchwork of care for elderly and disabled citizens causes the state to spend nearly three-quarters of its annual health budget on long-term care. His proposed remedy is to integrate the delivery system through care coordination and case management.

Considered a rising star in the Democratic party, Kaine was chosen to provide the minority response to President Bush's State of the Union address. In a preview of his speech, the governor in part blamed White House partisanship for current failures in the health care coverage system.

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