Coverage and Reform

How to best provide health insurance coverage in the United States is a complicated and controversial public policy issue, often fueled by deep philosophical and political differences. Regardless of political ideology, policymakers, researchers, and advocates agree that the escalating cost of health care is a major contributor to the high levels of uninsurance in the United States.

 

Among the many stakeholders that play a major role in the issue of health insurance coverage, states are one of the most critical. Not only do states regulate their own insurance markets, they also are providers and purchasers (e.g., through Medicaid and also by providing health insurance coverage to state employees as a large employer). Consequently, states have always been a part of the coverage debate as they struggle to maintain their public programs and effectively serve as the laboratory for new coverage models.

 

Policymakers have come to understand that the issues facing the states cannot be remedied by focusing solely on coverage and access issues; however, there is also increasing recognition that coverage expansions are necessary to have an effective and efficient health care system. Consequently, many states are combining coverage expansions with strategies aimed at improving the health care delivery and financing system while controlling costs as well. Likewise, states are demonstrating an increasing awareness that reform efforts targeted to cost containment can also promote healthy behaviors and more effective management of chronic conditions.