Unfinished Business

Healthcare was in the political spotlight for much of 2007 as state Legislatures debated coverage expansion, presidential hopefuls released plans for healthcare mandates and/or tax incentives to encourage more Americans to obtain coverage, and Congress continued its fight with President Bush over the reauthorization of the State Children's Health Insurance Program. That spotlight is expected to shine bright again next year, as much of the work from 2007 is still unfinished.

In California, for example, Gov. Arnold Schwarzenegger declared 2007 the year for healthcare reform in the Golden State. The Republican governor reached a late compromise with the State Assembly, which on Monday approved a plan to cover most Californians through a series of healthcare coverage mandates and subsidies. The state Senate, however, will not address the plan until 2008 as it seeks assurances that funding for existing programs and providers is not endangered by the expansion.

In Illinois, meanwhile, Gov. Rod Blagojevich took executive action to bypass the state Legislature and expand coverage to an additional 150,000 uninsured residents. But that plan is facing a legal challenge from the Illinois Coalition for Jobs, Growth and Prosperity, which filed a lawsuit earlier this month challenging the governor's authority to unilaterally change eligibility and expand coverage.

And at the federal level, Congressional Democrats will continue efforts to line up support for their plan to expand coverage to 10 million children at a cost of an additional $35 billion. A first test will come in January when President Bush's recent veto of the Children's Health Insurance Program Reauthorization Act of 2007 is due for review in the House.

In spite of the setbacks and delays, 2007 did include some significant highlights on the coverage front.

In Massachusetts, the state is reporting that more than 300,000 residents will have signed up for health insurance coverage under the state's new coverage expansion program. Slightly more than half enrolled through Commonwealth Care, the state-subsidized program, while another 70,000 will be covered by the Massachusetts Medicaid program. Overall, nearly 100,000 will be covered by a private insurer to comply with the state's individual mandate for coverage.

Maryland Governor Martin O'Malley was also able to hammer out a compromise with the state Legislature to cover approximately 140,000 uninsured Marylanders. The state program will expand eligibility for Medicaid and offer subsidies to some small employers who have not offered coverage to their low-wage workers.

And in Wisconsin, Gov. Jim Doyle approved a restructuring of the state's healthcare programs that will allow every family in the state to obtain either free or low-cost coverage for their children through its BadgerCare Plus program. Rates for middle-class families start at $10 a month and are capped at $68.25 per child. Enrollment opens in early February.

So what's in store for 2008? Will the issue remain a largely esoteric one to be debated ad nauseam in state houses and on the campaign trail or will our political leaders find a common voice and move forward on reforms? I'm not taking any bets, but I would be interested in hearing your odds on the outcome.

Editor's note: Health Plan Insider will not publish next week in light of the holidays. Look for your next issue to arrive on January 2, 2008. See you next year!