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Recent History of State Level Organizing for
Universal Health Care
21 State
Organizations work for Universal Health Care and are linked from the EINO home
page Go There Now These organizations are the best source of information on state level UHC organizing in those states. Tell them we sent you, if you call or email !
On this page we intend to present the important historical events
in state organizing for universal health care. There are a few resources relevant to this history which have been available at EINO longer than this webpage on individual states with "near universal" care:
1. Discussion of the historical precedent for the Right to Health Care, which is the state-by-state struggle and adoption of the Right to Education in the USA. See the discussion of this history in the form of our FAQ at EINO or Visit the history section of the website for the Right to Health Care.
2. Discussion among state activists in Oregon who led a failed attempt to adopt UHC in the year 2000. Oregon is of particular interest due to the experiment with so-called "near Universal Health Care". See the two downloadable (PDF) documents on the initial and later, more reflective, discussion of the Oregon campaign. CLICK HERE
3. Also the discussion of "Rationing Health Care" is particularly relevant to the UHC effort in Oregon. The Oregon plan for "near universal" health care was fated from the very initiation by its adherence to the principle that health care within the state would have to be rationed and that any UHC plan which was "realistic" needed to include the plan for rationing. CLICK HERE
These states have been singled out for discussion not because they currently have systems closest to UHC, nor are these states doing the most interesting work towards UHC. These states are discussed in detail here because in recent history many people believed or still believe mistakenly that these states had something that could be fairly described as universal health care.
In fact, THE MOST IMPRESSIVE STATE ORGANIZING on universal health care is being undertaken in the four states which have emphasized the human rights context of the struggle for universal health care - in the opinion of Project EINO. The state UHC organizations in FL, MA, MI, and NC are all emphasizing that health care is a right, for those state activists "Health Care is a Right, Not a Privelege" is more than a popular slogan, its an effective principle and a strategy at motivating broad and deep popular support. Read more details about the work of these states on the "Right to Health Care". CLICK HERE
OREGON
Please see the EINO document on the Oregon activists' discussion of the failure of the campaign for Measure 23. Many of their activists (Health Care for All Oregon ran the campaign for Measure 23) wrote in about rationing care or about "cost containment". This demonstrates the unfortunate legacy of the Oregon Health Plan, which early on became wedded to the concept of rationed care. Project EINO states categorically that rationing care cannot be part of any genuine UHC system. You can't cover some people in a state for just some of their medical needs and still call the system you are promoting "universal", not honestly.
Aren't we trying to convince people that all medically appropriate, necessary care can be provided in a UHC system and that this can be done without incurring additional cost to society over what we are now paying for some of us to be insured (temporarily, at our present employment)? And aren't we insisting that others, who are often the most at-risk or needy either fail to get the treatment or plunge extended families into poverty, just because of medical misforturne (that we are all running this risk in fact)?
Currently our health care is rationed by insurance companies who would cut us off from needed procedures to whatever extent they can get away with, in order to broaden their profit margins. Of course, we cannot tolerate unproven, untested or absurdly priced drugs and procedures to be charged to the public account on the whim of industry marketing crews. Efficacy, quality of life, extension of expected life and alternative treatments always will need to be reviewed and considered by medical professionals and guidelines developed for advanced procedures. But we need to have our most dedicated health professionals deciding these issues on the basis of overall patient welfare and without personal conflicts of interest.
Will health care be budgeted? In some sense of course it will. For the first time ever in this country, it will be budgeted responsibly, looking at the overall costs and savings. A state enacting UHC will be able to globally plan how services will be provided, but can do so with an ample budget, inasmuch as we now pay about twice per capita what any other industrialized country does (and don't get care for everyone as all other industrialized nations do). Having a rational, just global budget for health expenditures is not the same as rationing care. Its just the opposite !
Note that some of the arguments about rationing care and copays came from experts "supportive of UHC", even who teach courses in health policy. At Project EINO we have indeed read the books by some of these. They are unconvincing and usually begin with the concept of rationed care at the very onset. They also consistently fail to distinguish between rationing care and designing a system with a global budget - an ample one. It is unethical to assume a need for rationing health care while such tremendous profiteering remains in health care industries, not to mention wasteful redundant administration.
Why not first institute a system taking care of everyone's medical needs (at the level say afforded presently to federal employees) and then talk about the overall health budget when we can also take into account our savings, both direct and indirect from having everyone covered. We're talking 50 million + annual compensation! CLICK HERE Indeed the Oregon Health Plan has gradually deteriorated to the point where some half million Oregonians are completely without health insurance, health care costs are skyrocketing (double-digit annual increases) and those with insurance have many of the procedures they need excluded from coverage (every year more care has been stricken from coverage). The organizers in the state, Health Care for All Oregon, are calling for Single-Payer health care to be enacted.
In summary, (1) an initial commitment to the concept of rationing health care will doom any organizing effort to make health care universal, it adopts all of our opponents major arguments and incorporates their myths at the very onset of our work and (2) Such a system which was attempted by Oregon for a decade instituting and rationalizing health care rationing is easily eroded over the years by conservative politics and normal state fiscal forces. It will become a plan for marginal care serving most of the poor and working class, leaving room for continuing egregious profits of the pertinent industries coupled with expensive but adequate care for the health upper middle-class. (3) It is tainted with racism to feel a need to plan in rationing care at the same instant that health care is to become accessible equally to the traditionally underprivileged ethnic groups.
HAWAII
The "Prepaid Health Care Act of 1974" required required all employers to offer health care coverage. Hawaii has a unique ERISA exemption and a Medicaid 1115 waiver that provides flexibility in administering the program. The ERISA exemption was due to the earliness of Hawaii's plan (before ERISA was enacted). Provisions are made for working students according to hours working).
[In all other 49 states ERISA disallows state run programs from interfering with private plans apparently.] In 1989, a State Health Insurance Program (SHIP) was adopted as "gap" insurance for those persons not eligible for either Medicaid, Medicare or the employer mandate. SHIP is a partnership between government, private insurance and individuals/families. SHIP benefits are heavily weighted toward preventive and primary care, but also assist with catastrophic coverage.
Some impressive outcomes were reflected in 1991 health statistics: lowest infant mortality (tied with Vermont); lowest rates of premature mortality for heart disease(one -third lower than national average), cancer (one -fourth lower), and lung disease (one -half lower); and third lowest emergency room usage (one -third less than national average). And even though Hawaii has one of the highest costs of living in the nation, it has one of the cheapest insurance rates for small businesses.
Recent news articles on Hawaii's uninsured, hospitals running into the red and self-employed with 20% rate of uninsurance Article1 , Article2 , Article3 .
MAINE
The Dirigo Health Reform Act was developed by the Maine Governor's Office of Health Policy and Finance with significant input from health care policy experts and the Health Action Team (see Appendix A), a group of key stakeholders appointed by Governor John Baldacci. The Reform Act, Public Law 469, was enacted with bipartisan support and a two-thirds majority in each chamber of the Maine Legislature. Governor Baldacci signed the bill into law on June 18, 2003. The purpose of the Reform Act is to make quality, affordable health care available to every Maine citizen within five years and to initiate new processes for containing costs and improving health care quality.
A major premise behind the law is that successful health care reform must address cost, quality, and access simultaneously and with equal vigor. The law is built on the assumption that health reform cannot be done in a piecemeal fashion. If attention is paid only to access, costs will increase. If lowering the cost of care is the primary concern, access will be limited. And if quality is the sole focus, people will remain uninsured and costs will remain high.
Maine passed the bill on June 13, 2003 with the intention of making health insurance affordable to most of that state's 180,000 uninsured residents by 2009. The bill will allow individuals, the self-employed, and small businesses (less than 50 employees) to buy into a state-sponsored group plan that will also cover all state employees. Participation in the plan is voluntary, and benefits have not yet been determined. Employers who want to buy-in will be required to pay 60% of the premium for their workers, and the state is hoping to subsidize premiums for individuals earning less than $27,000 and families of four under $55,000. The Dirigo Health Plan will be offered to the participants by a private insurer.
In contrast to most states, which are tightening their Medicaid eligibility rules, the bill also seeks to expand the MaineCare Medicaid program. Provisions for financing the Dingo Health Plan and holding down costs are still being developed, but do not include known-effective measures such as single-payer financing to garner administrative savings, negotiated fees for services and medications, or global budgets for hospitals. Instead, the state is proposing using $52 million in emergency aid from Congress to the states (a one-time measure), a 4% tax on insurers gross revenues and a voluntary one-year cap on prices by insurers, doctors, and hospitals. Meanwhile, a single-payer bill is still under consideration in Maine, and advocates have gained the support of a large coalition of small businesses.
Across all groups studied in the focus study (workers, employers and self-employed) there seems to be a consensus that if state government can create a good
health insurance plan,private insurers should be allowed to sell and administer the plan. The
government should monitor how the plan is running, to make sure it is fair, that premiums are
not climbing out of control, and that benefits are being administered correctly. But, according to
participants, the government should not get involved in the administration of the plan because,
historically, the bureaucracy has not done a good job of administering such efforts. [Do most Mainers know that Medicare operates at 3% overhead vs. 20 - 30% for private insurers? We wonder what a government program could accomplish with twice the overhead of Medicare and still a small fraction of the overhead taken out by any private insurer.]
The Maine People's Alliance is the major grassroots organization leading the continuing battle for a real UHC system in the state of Maine. In private conversations with a few leading activists of that organization, Project EINO has learned that they recognize the Dirigo plan to be a positive "first step" towards real, stable Universal Health Care in the state - not at all the completed achievement of universal care.
See EINO's FAQ and references therein for more on Affordability of UHC .
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