Healthcare Reform in the United States: The Role of the States

Abstract

Although national efforts at healthcare reform in the United States have largely stalled, reform efforts at the state level have enjoyed surprising success - either independently of federal programs or within the latitude allowed by federal funding for the states. These state efforts hold great promise of extending access and healthcare coverage to uninsured Americans, improving quality of care, containing costs, and raising new revenues. These efforts are of great importance not only to other states, but also to other nations that already have universal healthcare and are now struggling with issues of coverage, cost, and quality.

It is commonly understood that reform of the United States healthcare system is greatly needed. Total national healthcare expenditures exceed $1 trillion annually and, at the present rate of increase, will surpass $2 trillion within the present decade. This burden is unacceptable, whether viewed as a percentage of domestic national product, exceeding 18 percent, or as a per capita expenditure, exceeding by nearly a factor of two to three times expenditures by other industrialized nations. The burden on individuals is onerous, unequal, and increasing.

At the same time, there are major deficiencies in coverage and quality. As to coverage, the U.S. Census Bureau reports that over 47 million Americans are uninsured. As to quality, the Institute of Medicine estimates tens of thousands Americans die from negligence in hospitals annually. By most quality measures, American outcomes fall far short of international standards, whether the criteria are simple mortality or more complex quality-of-life measures.

There is consensus that the United States cannot continue on the present path. A recent analysis by the Center on Budget and Policy Priorities concluded that if present budget policies are continued, by 2050, the national debt will increase from 37 percent of the national economy to 231 percent.

Keywords: health reform, state plans, universal healthcare, employers, uninsured, medicaid, SCHIP, play-or-pay