Improving and Increasing Access to Care: State Health Coverage Expansions Since 2004

Over the past few years, states have emerged from one of the tightest budget crises in recent history. In 2003, with fiscal pressures among the most prominent of state concerns, many states were forced to develop creative methods of providing health coverage options for those most in need. The NGA issue brief, Doing More With Less: Recent State Coverage Expansions, which was first published in November 2003—at the height of the budget crisis for many states—provided state policymakers with innovative ideas for action. Since that time, states have demonstrated a continued commitment to expanding coverage to the uninsured. This updated issue brief explores state progress in expanding coverage programs and highlights the most recent innovations in health coverage expansion.

There were 46.6 million uninsured Americans in 2005, an increase of 1.3 million since 2004. The rate of uninsured has increased by more than 5 million over the last four years due to various factors, including rising health care costs, decreasing employer-based coverage, and only modest increases in publicly funded coverage.

As the number of uninsured Americans increases, the costs of treating them are shifted between individuals, communities, and governments. For the uninsured individual, lack of coverage translates into the likelihood of poorer health and health outcomes and holds the individual responsible for their health care costs, often compromising their financial stability. The problem of uninsurance in communities appears in the form of an overall decrease in access to hospitals, emergency room care, specialty services, and a lack of community wellness. Local and state governments also must bear the cost of uninsurance as they reimburse providers for uncompensated care.

Due to its broad scope and complexity, the lack of health insurance in America does not have a quick fix. However, to address the problem of the uninsured, several states recently enacted plans to increase coverage and access for many Americans. States have expanded and implemented:

• steps toward universal access to health care coverage, which combines several initiatives to offer residents access to affordable health care;
• premium assistance programs, whereby states provide subsidies to low-income uninsured persons to assist them in purchasing private insurance for themselves and their families;
• access to new insurance products to extend affordable coverage to small businesses, self-employed individuals, and other uninsured residents;
• tax credits for small businesses who offer health care and paid part of their employees' health insurance expenses;
• children's health coverage, through both SCHIP program expansions and innovative 1115 waivers; and
• access to community health centers as an alternative, non-emergent care option for uninsured populations to receive primary care services.