Insurance Coverage Introduction

States that Stand Out

SUCCESS STORIES

Delaware and Iowa
Both states have a long-standing commitment to confronting the problem of the uninsured and have achieved the second- and third-lowest adult uninsured rates in the U.S. In Delaware, consistent attention to the problem has come through the work of the 14-year-old Delaware Health Care Commission. Iowa’s strengths are in outreach and education.

Maine
This is the state to watch this year. New legislation sets the stage for universal coverage, with a phase-in to begin in July. Maine has a three-pronged attack on the problem, focusing on quality and cost control as well as access. A key element has the state taking on the role of purchaser for small business health plans, with an eye toward eliminating hassle and lowering costs.

Minnesota
With only 10 percent of non-elderly adults uninsured, Minnesota has the most successful insurance record of the 50 states. It has the second highest rate of employer coverage, the most generous public coverage for parents, and a state-funded program for childless adults, though this was cut back some last year. A strong safety net is also in place for the people who still fall through the cracks.

New York
Despite having a low rate of employer coverage, New York’s expansive public programs, including one for childless adults, have helped the state make headway in covering low-income, non-elderly adults. In addition, a new program will make insurance more affordable for small businesses that employ low-income employees by shifting risk to the state for high-cost cases.

Rhode Island, Vermont and Wisconsin
All three states emphasize full family coverage, providing insurance to parents at higher levels of income than most states. One bonus to this approach: When parents are insured, children also end up getting better preventive medical care.

TROUBLE SPOTS

California
The state’s extreme budget problems are making a bad situation worse. With the rates of uninsured already higher than in 45 other states, California made several changes last year that will dramatically reduce the number of people covered by Medicaid. Proposals are also on the table to cap the number of immigrants covered. A new law to expand health care to the uninsured by mandating employer coverage was signed by former Governor Gray Davis but faces legal and political challenges.

Louisiana and Oklahoma
These states cover parents only at the very lowest of income levels. Their bare-bones public coverage contributes to very high rates of uninsured adults. Oklahoma’s situation particularly is likely to worsen because it has dropped coverage for the “medically needy” — people who qualify for Medicaid because of high health bills.

Oregon
A long-time model for other states, Oregon’s innovative health plan has fallen on hard times. With a get-tough policy that kicks people off of public insurance if they miss premium payments, the state has reduced the numbers of adults covered by about a third. It also ended its inclusion of the “medically needy,” which had covered selected population groups. If last year’s tax increase is repealed, the Governor says the Oregon Health Plan, which tried to expand the number of people covered by setting limits on benefits, will cease to exist in its current form.

Tennessee
An adult uninsured rate of 14.6 percent, the lowest in the South, shows the Volunteer State did something right in TennCare. But the beleaguered program provides other states with many lessons of what not to do. The state plunged into a near-total managed care environment without a solid infrastructure of managed care organizations. A restructuring of the program led to vastly weakened cost controls. A major study recently concluded that TennCare is unsustainable in its current form.

Texas
The state dropped into 50th place in its rate of insured adults last year. Texas has low rates of employer coverage, covers parents only at very low income levels and has no coverage for childless adults. Cutbacks in Medicaid eligibility and the elimination of the state’s medically needy program in 2003 will only compound the problem.

Copyright © 2004, Congressional Quarterly, Inc. Reproduction in any form without the written permission of the publisher is prohibited. Governing, City & State and Governing.com are registered trademarks of Congressional Quarterly, Inc.