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February 09, 2008

Growing Pains of Universal Coverage for Californians

It has not been a good few weeks for state efforts to provide universal health insurance. A pioneering program in Massachusetts to cover hundreds of thousands of uninsured has cost a lot more in its opening phases than originally projected, raising fears about its sustainability. An even more ambitious proposal to cover millions of uninsured in California collapsed in the State Senate over fears that it would prove unaffordable.

Neither setback means that states should stop trying to cover the uninsured — especially since the federal government is AWOL. The problems do suggest that officials need to make the most realistic possible cost estimates and be prepared to provide resources to subsidize coverage for those who can’t afford it.

The Massachusetts plan was the result of compromises between a former Republican governor — Mitt Romney, who lost his enthusiasm just in time for the presidential primaries — and a Democratic Legislature. It required all residents to buy health insurance or suffer financial penalties, subsidized those unable to afford it, imposed a small fee on businesses that failed to provide employee coverage and set up a marketplace where people can buy portable insurance with pretax dollars.

The financial problems are mostly because of underestimating the number of uninsured and the rate at which they would sign up for subsidized coverage. As a result, the state, which had originally expected to spend $472 million on subsidized insurance this fiscal year, now expects to spend about $150 million more than that. It anticipates spending almost $870 million next year.

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Posted by healthinsurance at February 9, 2008 07:20 PM