From New England to the Golden Gate Bridge

Frustrated by the lack of action or even attention at the federal level, states and local governments are looking for creative ways to expand programs to reach the 47 million Americans without health insurance. There have already been a number of creative initiatives by states and localities over the last five years to cover more of the uninsured, which deserve our review.

Massachusetts recently passed major health care reform, which has widely been reported as an innovative way to provide for universal health coverage. The Massachusetts reform has grabbed the nation’s attention and spurred a great deal of discussion about what states can do to try to expand coverage. Massachusetts’ success story has served as a catalyst for discussion of creative expansion options at both the state and federal levels.

But Massachusetts is not alone. Several states and localities have started with small program expansions; a few have passed large scale reform. States and local governments are reaching out to assist small businesses, or finding ways to expand coverage to those too poor to afford health insurance but not poor enough to qualify for Medicaid. Many expansions offer limited benefit packages, or implement policy changes that are designed to increase affordability. The tools used to finance expansions vary widely, including using federal funds or dedicating specific state funds. This paper highlights many of these states and a few local areas, and the various tools they are using to reach the uninsured.

From New England to the Golden Gate Bridge, state and local governments are acting as laboratories for the rest of the country, and more importantly, they are yielding results. But, while such state experimentation is both helpful and hopeful, national reform should not be done piecemeal at the state and local levels. Rather any reforms done at the state level should help inform Congress about what works best so that national reform can occur expeditiously and without false starts. State reforms should be catalytic and exemplary to, not substitutes for, national reform.

For the complete paper, please see the attached PDF version below.