IN THE STATES: Chutes and Ladders, Ballot Edition

Tuesday's election brought a series of health care initiatives to state ballots. Some, like Prop 101, blocking the state of Arizona from enacting universal coverage, are still too close to call. Others, like Michigan's Prop 1 on medical marijuana, aren't our bag (we swear officer). And still others, like measures passed in Montana and Maine, remind us that health reform at the state level can sometimes seem like a game of Chutes and Ladders.

For the more than 30,000 children in Montana without health insurance, the passage of ballot initiative I-155, "The Healthy Montana Kids" plan represents a major step forward. The measure expands the eligibility for Medicaid and SCHIP to uninsured children, whose family income is below 250 percent of the federal poverty level (previously only those in Montana with incomes below 175 percent of FPL were eligible). The plan is expected to cost around $22 million annually and will cover most of the state's uninsured children. It will be paid for with existing revenues from an insurance premium tax.

As we noted earlier this week, expanding SCHIP may be one of the first items on the to-do list for Congress and the next administration. Why? Well, in addition to being cute, children tend to be pretty cheap to cover, making for good politics and publicity.

Malt beverages are also pretty cheap, and the citizens of Maine voted to keep them that way. In voting yes on Question One, ("The People's Veto") voters in Maine rejected recent legislation that would have funded the state's DirigoChoice health program, with a beverage tax on beer (included under the Malt Beverage category in Maine statute), wine and soda, as well as a 1.8 percent surcharge on paid insurance claims. For proponents of Dirigo, the results were a step back, as the plan is currently funded under an unpopular and unpredictable Savings Offset Program (SOP) which taxes insurers based on estimated savings from the State's insurance programs. The SOP has also been challenged in a lawsuit filed two weeks ago by the Maine State Chamber of Commerce.

Like Chutes and Ladders, health reform isn't easy. You take a few steps forward but constantly worry you'll go slip-sliding back toward square one. States in particular have a hard time, given the budget constraints in this weak economy. In every case, whether it's Maine, Montana or Massachusetts, the federal government has had an important part to play if the states want to keep climbing the health care ladder.