2008-10-16 / Features

Pa. Healthcare Battle Shows States Struggle Alone


HARRISBURG, Pa. (AP) - When Gov. Ed Rendell first proposed an ambitious plan to expand subsidized health insurance to uninsured Pennsylvania adults, he wanted the state to step into a void left by the federal government's failure to act.

Nearly two years later, access to health insurance has become a hotly debated issue in the presidential race. But the void remains.

The current two-year legislative session is ending without a healthinsurance compromise between the Democratic governor and Senate Republicans. The Senate GOP says that in the face of a weakening state economy, Rendell is overreaching with proposals that would require tax increases to sustain them over the long haul.

But Pennsylvania is far from alone in falling short of Rendell's goal.

To date, Massachusetts has made the greatest progress toward reducing the ranks of the uninsured through its landmark 2006 health law. It cut the proportion of uninsured adults from 13 percent to about 6 percent over 18 months.

But similar initiatives in other states, such as California, Illinois and New Mexico, have been defeated in political arguments over how to pay for them, according to the Kaiser Commission on Medicaid and the Uninsured, based in Washington, D.C.

"Health reform at the state level is a very heavy lift for any state,'' said Diane Rowland, the commission's executive director. "What you also see is, health reform ... is easier when economic times are good and more difficult to accomplish and more difficult to sustain when the economy goes down.''

In the first three months of the current fiscal year, Pennsylvania racked up a revenue shortfall of $281 million. Although Rendell ordered a statewide hiring freeze and other spending cuts to help stanch the bleeding, Senate Republicans warn if current trends continue the yearend deficit could exceed $2 billion.

About 767,000 of the state's adults lack insurance - roughly 8 percent of all adult Pennsylvanians. More than 118,000 are on a waiting list for the state's adultBasic health insurance program for the working poor, which currently insures 49,000 who cannot afford private insurance but who make too much money to qualify for Medicaid.

Throughout the debate, Senate Republicans and Rendell have clashed over the extent to which tax dollars should go directly toward covering the uninsured. The GOP says it is willing to entertain efforts to reduce the adultBasic waiting list, but it has quibbled with Rendell over whether existing revenue sources he has proposed to eliminate the waiting list within three years are sustainable.

"Tackling the health care access problem in a steady, incremental way may not have the splashy effect of a grand new program, but it would clearly continue Pennsylvania's position in the forefront as one of the top six states meeting the needs of the uninsured,'' Senate Republican leaders said in a letter sent last week to Rendell.

Pennsylvania has made other strides toward improved health care access in recent years. It expanded a health insurance program for needy children - now dubbed Cover All Kids - and allowed more senior citizens to become eligible for prescription drug assistance.

But even with the general election less than a month away, Rendell is unwilling to wait for a new president to step in with an answer to the question of how to cover the uninsured.

Democratic presidential candidate Barack Obama favors universal health care, but Rendell noted that Obama has acknowledged that, if elected, it would take him a full term to pass the measure and another two years to implement it.

"We would be looking at 2014 at the earliest,'' Rendell said last week. "In the meantime, Pennsylvanians ... would have to continue to suffer.''

Rendell has promised to keep chipping away at a state policy solution until he leaves office in 2011.

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