- The Washington Times - Monday, June 6, 2005

Federal lawmakers will have to offer states a variety of options to successfully reduce the number of uninsured Americans, according to a study being released today.

Federal initiatives such as tax credits for health insurance and an expansion of federal health care programs probably would reduce the number of uninsured Americans, but not across all states, the report said.

“The message is that there is no single solution that will work for all the uninsured, so we need a variety of solutions,” said Sherry Glied, head author and a health policy professor at Columbia University.

The study, which was released in the online version of health policy journal Health Affairs, examined five federal health care proposals that have been considered but not implemented to try to reduce the uninsured rate. More than 45 million Americans had no insurance in 2003, according to the latest data from the U.S. Census Bureau.

The purpose of the study was to examine how successful the programs would be on a state level, Ms. Glied said.

“The uninsured population is extremely varied in each state,” with uninsured Americans widely ranging in income level and accessibility to health care, she said.

The Health Affairs report studied the state effect of national health insurance tax credits for consumers and small businesses, two expansions in Medicaid coverage, and larger coverage in the State Children’s Health Insurance Program, the federal health care program for children.

Consumer tax credits and expanding the eligibility of poor adults who could enroll in Medicaid, the federal health care program for the poor paid for by the states and federal government, would have the most effect, Ms. Glied said.

Tax credits for consumers, which were projected to cover 11 percent of the nation’s uninsured, would lower uninsured rates by more than 15 percent in states like Utah and Kansas that have low health insurance rates and a poor uninsured population.

However, tax credits would have little effect in states like New York and New Jersey because they have high health insurance rates, the study said.

Expansions in Medicaid coverage would reduce the uninsured rate by 18.3 percent in states like Alabama and West Virginia, which have higher health insurance rates and no previous-coverage expansions. But the District and states like Arizona and Delaware probably would see no change from the expansion because they already cover more low-income consumers, the report said.

Ms. Glied acknowledged the report did not research the costs states would face if the federal programs were enacted.

Medicaid, in particular, has become a crippling problem to state budgets, crowding out funding for programs like education and transportation.

The federal-state program made up 18 percent of Virginia’s state expenditures last year, totaling $4.01 billion of the state’s $21.7 billion in costs.

Medicaid cost Maryland $3.83 billion in the state’s fiscal 2004 ended June 30. The state’s total spending, which included general funds, federal funding and other sources, reached $22.5 billion during that period.

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