On health care, states must lead

Karen Keiser, Adam Thompson

Like politics, it seems all health-care reform these days is local. While Congress and President Bush have failed to address our failing, costly and disjointed health-care system, states have stepped up to the need by enacting reforms to achieve quality and affordable health care for all. States are providing the leadership that is moving health-care reform across state lines and building momentum for national reform.

Yet, some people argue that state-based reform is destined for failure and a distraction from national reform. They cite budget constraints and examples of state initiatives that didn't live up to their promise of universal health care. The fact is, however, that past efforts didn't fall short because they couldn't succeed, but because they didn't go far enough. Many states have economies larger than nations which do provide universal health care.

San Francisco, with 82,000 uninsured residents, is well on its way to becoming the first American city to guarantee health-care coverage for all residents through its Healthy San Francisco program. Some 88 miles away in Sacramento, Gov. Arnold Schwarzenegger and legislative leaders, notably Speaker Fabian Núñez, are in special legislative session to iron out differences and enact a major health-care reform package.

Elsewhere, the states of Washington, Oregon and Hawaii were early leaders in health-care reform. While these early efforts achieved mixed results, they helped show the way for recent initiatives in Maine, Vermont, Illinois and Massachusetts. These, in turn, have set examples for states making headlines this year and states planning to tackle reform in 2008; including Wisconsin, Pennsylvania, Colorado, New Mexico and, again, Washington and Oregon.

Congress, in turn, has followed the lead of the states. A perfect example is the wildly popular State Children's Health Insurance Program, or SCHIP. SCHIP came about when states began covering children who weren't eligible for Medicaid but whose families couldn't afford private coverage. Today 6.6 million children across the country are covered by SCHIP. The state of Washington is one of many states using SCHIP as a base to move toward health care for all children.

The new crop of state reforms built on previous efforts, offering bolder reforms to guarantee access to care and require hospitals and doctors to better coordinate patient care, as in Wisconsin; improve health care quality and reduce medical errors, as in Pennsylvania; and wring inefficiency out of insurance companies, as in California.

Still, some question the ability of states to succeed and even go as far as to suggest that energy pushing state reform would be better spent advocating for a Washington, D.C.-brokered national solution.

But, is it fair to, or even safe for, the 47 million Americans without health insurance - and the millions more who fear they may not have it next year - to wait on Washington, D.C., to act?

Every few years since the 1940s, there has been a renewed push in Congress for national health-care reform. Although a number of congressional leaders such as Sens. Barbara Boxer, Bernie Sanders, Russ Feingold and others have attempted to pass major legislation, their efforts have failed, unable to withstand the heavy lobbying of the insurance and pharmaceutical industries - and also because of that quirky yet fateful Senate rule called the filibuster. The filibuster requires 60 votes in the 100-seat Senate to close debate and hold an up-or-down vote on a bill. This institutional roadblock is a major reason Congress has not been able to move comprehensive reform.

The simple fact is we need states to be leaders on health-care reform if we are ever to have a federal solution. States already provide millions of Americans with health care, including state employees, low- and middle-income children and families, small businesses and long-term care for seniors. States have the networks, the outreach and the enrollment systems to make programs work, many of which are based on Medicaid and SCHIP and funded jointly by states and the federal government.

Because of states acting over the past 15 years, 50 million Americans are now covered by Medicaid and SCHIP, almost double the number covered in the early 1990s. Although private insurance premiums have steadily outpaced wages during this time and more employers are dropping health benefits, uninsured rates have remained relatively steady across the country because states have expanded health-care programs and provided coverage to those that would otherwise be uninsured. States are responding to this crisis and building pressure on our leaders in Washington to do the same. The "uniquely American system," which most experts agree will someday emerge, will include a strong state-federal partnership ensuring all Americans have the health care they need, when they need it.

Senator Karen Keiser is chair of the Senate Health and Long Term Care Committee in Washington State. Adam Thompson is the senior health policy analyst at the Progressive States Network and formerly worked in Maine Gov. John Baldacci's Office of Health Policy and Finance.

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