WASHINGTON — Healthcare reform may be dead in Washington, but a growing number of states -- under both Republicans and Democrats -- are taking steps to expand medical insurance coverage.
Faced with a problem they find increasingly hard to ignore, governors and legislators in at least 20 states have reached agreements to expand access to healthcare by squeezing money from existing health programs and taking other politically difficult steps, including some tax increases.
In Illinois, Democratic Gov. Rod Blagojevich is about to sign a bill providing affordable health coverage for uninsured children of working parents.
Massachusetts has taken on a bigger challenge. There, Republican Gov. Mitt Romney and the Democrat-controlled Legislature are negotiating over competing plans to cover all of the state's half-million uninsured residents.
"The fact that nothing is happening in Washington is not deterring states," said Alan R. Weil, executive director of the National Academy for State Health Policy. "The lack of action in Washington is not because of the lack of a problem. It's because of a lack of agreement and, frankly, a lack of consequences for failing to address the issue. At the state level, if you have a Medicaid budget problem or a growing number of uninsured, you have to tackle the issue."
Given the seemingly intractable economics of healthcare, it is not clear whether the states will be able to sustain the efforts they have launched. Controlling costs continues to be difficult. States' revenue can fluctuate. And many are legally barred from running deficits.
But traditional employer-based coverage, the cornerstone of the old system, continues to shrink as the average cost of a family plan approaches $11,000 a year. And some experts think the modest but growing efforts by states could help jump-start a national debate.
"If any of these states succeeds, it could provide impetus for a national debate in later elections," said Robert Blendon, a public opinion analyst at the Harvard School of Public Health. "If the Iraq war and terrorism were to go away, healthcare issues are going to pop right up because they just bother a lot of the public and voters."
The renewed interest in expanding coverage is unexpected.
Earlier this year, headlines focused on Medicaid cutbacks in Tennessee and Missouri that are expected to leave tens of thousands without coverage. And Florida's experiment with managed care for its poor is being watched warily by liberals.
