RX for Change: Confronting the health care crisis in Kansas

Dec. 5, 2005

By Sarah Kessinger

Harris News Service

The federal government dropped it like a hot potato years ago, but several states now are considering proposals to provide health insurance for all residents.

With the number of uninsured steadily rising and the average consumer struggling with the price of health care, 19 states considered universal coverage this year.

“No states have gotten there, but it's not for lack of trying,” said Larry Levitt, vice president of the Kaiser Family Foundation, which researches health care policy.

Hawaii is probably the closest, he said. Since the 1980s the Aloha State has required all but its smallest employers offer employees low-cost insurance.

A few other states tried at the time but never pulled off any wide-ranging program. Congress failed to address it, and not until recent years did new proposals begin to surface in the states.

“Part of that was the hangover effect from the Clinton reform effort,” Levitt said. “Everyone had looked to Washington for a solution, and that didn't work.”

Two factors drive today's renewed interest: The number of uninsured continues to rise and people are acknowledging it's a problem. Also, state tax revenues are improving.

“There's a sense that they can do something about it,” Levitt said.

Some states are taking baby steps, expanding Medicaid programs, primarily for children. A foundation study in October found that 20 states expanded access to Medicaid, health insurance for the poor and disabled.

“Now we're seeing a small handful of states looking at major reform efforts,” Levitt said.

Those include Massachusetts, which is looking to cover most of its uninsured.

And Maine in the last couple years initiated a universal coverage effort. The state contracted with private insurers to cover the uninsured.

“There are a group of states really moving forward,” said Laura Tobler, analyst with the National Conference of State Legislators in Denver.

Kansas has yet to debate any proposals on the issue. Gov. Kathleen Sebelius won't pitch one to the 2006 Legislature, said spokeswoman Nicole Corcoran, despite a conservative think tank's recent op-ed piece in some Kansas newspapers stating she would have a proposal patterned after Maine's program, known as Dirigo.

Health policy staff reviewed what Maine is doing, Corcoran said, to determine how to build a public-private partnership in Kansas to help small employers provide coverage to their workers.

The Kansas Business Health Partnership, an effort of small business leaders and public officials led by state Insurance Commissioner Sandy Praeger, is trying to get such a program off the ground.

At the same time, Kansas remains among the many states struggling with the Medicaid program's double-digit cost increases. Sebelius sought to expand Medicaid coverage to more low-income working families earlier this year, but legislators showed no interest in paying for it with a proposed tobacco tax hike.

Still, other states' expansions have succeeded.

Iowa and New Jersey offer coverage to more low-income parents under Medicaid. Illinois legislators recently expanded their federal-state Child Health Insurance Program to assure coverage for all the state's children.

New Mexico launched a partnership with private business to expand Medicaid to more of the working poor.

Meanwhile, Congress appears headed toward cuts in federal support of Medicaid, adding pressure on states to cut their rolls or find new revenues.

States seeking new solutions, such as universal coverage, have not avoided cost struggles.

“This has been ongoing,” said Tobler of state fiscal difficulties. “Revenues have improved so there's some lessening of the crisis, but now states are looking long-term and saying, ‘How are we going to be able to afford it if costs continue to grow?' ”

Mounting budget pressures forced Missouri and Tennessee to cut off many residents from Medicaid.

But both states still insure poor adults at a higher level than Kansas, which is among the most restrictive states.

“It's always really hard to compare programs across state lines,”Tobler said. “Every program is a little bit different. You can't really compare Kansas to, say, California because California covers way more people and has a strong managed care program.”

What most states, including Kansas, have in common are efforts to run more efficient Medicaid programs with more predictable costs.

A Kansas legislative task force is preparing a report on the issue for the upcoming legislative session.

“There have been states, such as Minnesota, Vermont, Massachusetts and New York, that are more accepting and open to creative health proposals,” Tobler said. “And Oregon and Washington have been real leaders in health care.”

Their success comes down to one issue, she said.

“Studies have shown it has to do with strong leaders.”