If a state wants to successfully expand health coverage to its remaining uninsured, one of the key steps it must take is to ensure stakeholders like health insurance companies are on board.
That’s one of the findings in new research from the University of Pennsylvania, which analyzed and compared five states’ attempts to achieve universal coverage.
Out of the five states studied—Massachusetts, Vermont, Colorado, California and Nevada—Massachusetts was the only one that was successful in its efforts. The state’s healthcare reform legislation not only resulted in 97% of its residents having coverage but also became a model for the national coverage-expansion effort that resulted in the Affordable Care Act.
Massachusetts’ model worked because it enjoyed bipartisan support, avoided massive growth in government spending and maintained the balance of funding across both public and private sectors, researchers said.
Even more insights can be gleaned, though, by examining the state-led efforts that failed. One example is ColoradoCare, a ballot initiative that would have set up a taxpayer-financed system of universal health coverage. It was defeated after facing opposition from both ends of the political spectrum as well as various industries—including health insurance companies.
Then there’s the Healthy California initiative, which would have set up a single-payer system in the state but was shelved last June. That measure faced well-funded opposition from parties whose livelihoods were at stake, including health insurers, researchers said. That said, it is likely to be reconsidered in the 2018 legislative session.
And in Vermont—which tried to pass a bill that would set up a single-payer, government-financed healthcare system—Blue Cross/Blue Shield was one of the members of a coalition that challenged some of the bill’s assumptions about provider payments and administrative savings.
One of the lessons states can learn from such findings, the analysis said, is to realize that it’s crucial to build a “broad stakeholder coalition” in support of coverage expansion proposals.
“Influential stakeholders who feel left out, or who feel their interests may be threatened, are likely to galvanize opposition to efforts to expand coverage,” it said.