Last week, one day apart, two governors took dramatic steps that could crystallize a healthcare debate developing in the states -- even as Washington mostly averts its eyes from the problems of declining access and rising costs.
On Tuesday, Democratic Gov. Rod Blagojevich signed legislation making Illinois the first state to guarantee all children access to health insurance.
The next day, Republican Gov. Mark Sanford of South Carolina asked the federal government for permission to shift responsibility for providing health coverage for the state's poorest citizens primarily to private insurance companies.
These divergent initiatives signal an escalating competition to develop models for coping with the slow-motion crisis in healthcare.
Several Democratic-leaning states are rallying around plans to ensure universal coverage for children as a first step toward expanding access for adults.
Bill Richardson, the Democratic governor of New Mexico, says that in his next budget he'll propose to ensure universal coverage in his state for all children 5 or younger. Anthony Wright, executive director of the liberal group Health Access California, says activists are planning a state ballot initiative next November that would fund universal coverage for children through a cigarette tax increase of $1.50 a pack.
Blagojevich says he is hoping his action will encourage more states to fund universal coverage for children; nationwide, about one in nine children are uninsured. "If we can do it in Illinois, other states can do it," he says. "The idea that we are going to wait around for Washington or the Bush administration to do this is not a good use of time."
Conversely, the hot idea in Republican states is giving private health insurance companies the principal authority for operating Medicaid, the joint state-federal healthcare program for the poor. Sanford was actually the second GOP governor to propose such a shift; Florida's Jeb Bush has already won approval from Washington for a test he'll begin next year, assuming the Legislature gives its final blessing in December.
Last week, approving a proposal from Rep. Mike Rogers (R-Mich.), House Republicans nudged other states to follow; the House authorized a five-year, 10-state test of Health Opportunity Accounts, which would allow low-income families to buy healthcare directly from doctors or insurers as an alternative to Medicaid.
