States take the initiative on universal health care

Colorado becomes latest to act with a bill aimed at giving coverage to the poorest.

DENVER // Not waiting for President Barack Obama's promise of healthcare reform at the federal level, Colorado looks to become the latest US state to try to extend health coverage to its poorest residents. The Colorado Healthcare Affordability Act, or CHAA, won initial approval in the state House of Representatives last month and now faces the Senate. Democrats, who dominate both houses of the state legislature, call the bill a major milestone on the road to universal coverage. Republicans have a different spin. "Is this just another step towards socialised medicine?" asked Spencer Swalm, a conservative state legislator. Debate over private versus state-provided health coverage is one of the most divisive political issues in the United States. Mr Obama had promised a major overhaul of the country's healthcare system, which both the Democrats and Republicans agree is badly broken. But the economic meltdown and the multibillion-dollar bailout packages that followed have effectively forced the Obama administration to put that plan on hold. Despite concern about the cost of changing the healthcare system, about two-thirds of the public believe Mr Obama should press ahead with reform, according to the Kaiser Family Foundation, which tracks public opinion on healthcare issues. But until that happens, Colorado's legislators say they want to take matters into their own hands. "What we are taking is a giant step forward," a Democratic state representative, Jim Riesberg, a co-sponsor of the bill, told The Denver Post. Colorado is not the first state to try to mandate that residents who cannot afford health insurance, or who do not receive it from their employer, get healthcare free of charge or at deeply discounted rates. In 2006, Massachusetts passed a bill, modelled on the state's policy of requiring car owners to buy auto insurance, requiring all its residents to purchase health insurance or face legal penalties. Universal coverage gave state residents expanded choices, some subsidised by the state, which ranged in cost from about $250 (Dh918) per month to nearly free. Advocates of universal coverage argue that costs go down when everyone is paying into the system. But critics argue that the Massachusetts bill has actually led to increased healthcare costs for employers and the state. California, Maine and Hawaii, among other states, have also tried to extend healthcare coverage, with varying rates of success. Dozens of states are studying strategies ranging from increasing taxes to subsidised insurance programmes. "No matter what happens at the federal level, I remain convinced there will be a role for state's providing coverage," said Neva Kaye, senior programme director at the National Academy of State Health Policy. Advocates of the Colorado bill say the deepening US recession makes their proposal all the more urgent. Arguing that thousands of low-income Colorado families are "just one illness away from financial disaster", Mr Riesberg called his bill an "ingenious step to keeping health care affordable for everyone". With medical costs in the United States skyrocketing and the number of uninsured on the rise, the Kaiser Family Foundation says half of all US households report having cut back on health care in some way or another - usually by replacing costly pharmaceuticals with home remedies, or by skipping routine checkups. But that creates other costs to the system. Many individuals who forgo treatment at earlier stages of illness later find themselves in the emergency room facing far more expensive treatment. In Colorado alone, unpaid emergency room visits cost hospitals more than $375 million annually, according to the Colorado Hospital Association. And those unpaid bills always rise when the economy sinks and the ranks of the unemployed and uninsured climb higher. The CHAA would impose a universal fee - or tax - of about five per cent on all hospital bills, which would be matched by federal Medicaid funds. Together those funds would generate $1.2bn to expand health coverage for the 800,000 Coloradans who have no insurance. Critics complain that the bill will simply shift costs to the insured and the wealthy, and say it does little to address systemic problems crippling the healthcare system. "This sounds like a way to get you to pay for other people's health care, and not address the real problems of high medical and insurance costs," wrote Brian Schwartz in a blog on the Patient Power website, which opposes the government's oversight of healthcare issues. But many analysts say trying to regulate medical and insurance costs is a job for the federal government, while states have a responsibility to take care of their poorest citizens. "I think it is a route towards real reform," Ms Kaye said. "And I think it is wise for states to move on this because no one knows what is going to come out of federal reform." [e-mail]