Universal Health Coverage Attracts New Support

Vermont enacted legislation last year that seeks to expand coverage so that at least 96 percent of residents will have insurance by 2010. Illinois began a major expansion of coverage for children in 2005. That same year, Maine began implementing a plan whose goal is to cover all of the state's 130,000 uninsured residents by 2009.

Other states considering expanding coverage include Connecticut, Indiana, Iowa, Louisiana, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina and Wisconsin, according to the National Conference of State Legislatures.

All the state activity is adding pressure on politicians in Washington to act on a problem that grows worse year by year. Recent census figures show that a record 46.6 million Americans, including 8.3 million children, had no health insurance in 2005, up from 39.7 million in 1994. Employer coverage is more expensive and less available.

"As usual, Washington is behind the rest of the country," said Andy Stern, president of the SEIU. "We're ready to have a very bipartisan solution. What you are seeing now that you didn't see in 1994 is that everyone is on the same side saying, 'We want universal coverage.' The only question is, 'How?' "

Ah, yes, "how" -- and how to pay for it.

Expanding coverage is a costly proposition, and Democrats, in control of Congress for the first time since 1994, have pledged not to pass major new spending proposals unless other programs are cut to avoid increasing the federal deficit.

While there is bipartisan support for reauthorizing the decade-old state-federal Children's Health Insurance Program, which covers more than 4 million children at a cost of $5 billion a year, experts say at least $12.7 billion more is needed over the next five years just to keep covering the same number of kids.

Moreover, President Bush has given no sign of departing from his advocacy of special tax-favored savings accounts and changes in the tax code as the best ways to make health insurance more affordable. In his State of the Union speech this week, Bush plans to propose more such changes and to announce a new initiative to help states get more residents into private insurance.

"We must address these rising costs so that more Americans can afford basic health insurance," the president said Saturday in his weekly radio address. "And we need to do it without creating a new federal entitlement program or raising taxes."

Despite the new enthusiasm, in the short run, most attempts to expand coverage will probably continue to happen at the state level, some lawmakers said. Federal efforts will be largely incremental and devoted to helping the states find their way.

"The states become laboratories," said Rep. Frank Pallone Jr. (D-N.J.), chairman of the House Energy and Commerce subcommittee on health. "Politically that's necessary. If we tried to adopt a universal health-care plan on the federal level, we probably wouldn't have the votes."

Sen. George V. Voinovich (R-Ohio), a member of a bipartisan group that wants to steer new grants to states, called health care "the greatest domestic problem" but also said that "the truth of the matter is that dealing with this problem between now and the election is not realistic."

"Congress is not going to act in a major way to deal with this access problem in the next couple of years," said Sen. Jeff Bingaman (D-N.M.), another member. "That's the unfortunate reality that we're facing. And so we're saying most of the effort that is possible is at the state level and at the local level. And we want to encourage it and we want to provide assistance."

But ultimately, Washington will have to do more, said Charles N. Kahn III, president of the Federation of American Hospitals.

"At the end of the day, I think the federal government and the federal taxpayers have a responsibility," said Kahn, whose organization was among those calling for $45 billion to cover children. "Clearly, there are states that are looking into this. They can come up with some resources. But we feel that in order to get the ball rolling from where we are now, this is the role that the federal government needs to play."