Abstract: Pursuing national health care reform remains a priority for the President, Congress and the public. Policymakers have committed to passing comprehensive legislation by the end of the year. Expanding coverage to the uninsured as well as addressing health care cost and quality issues have emerged as the dominant drivers for systematic reform. Leading health reform proposals rely on a combination of public and private approaches to expand coverage, control costs and improve quality with shared responsibilities across employees, employers, government, consumers and insurers.
In the absence of strong federal leadership, states began to expand coverage to reform their health care systems to address the growing number of uninsured residents in their state. By 2008, Massachusetts, Maine and Vermont enacted universal coverage plans for all of their residents and some other states have proposed comprehensive reform. However, state fiscal capacity, structural deficits and now a worsening economy and severe state budget shortfalls have limited states’ ability to further advance coverage initiatives. While we can learn from the experiences of pacesetting states to inform future federal action, the fiscal crisis makes it difficult for many states to achieve health care reform on their own.
As the health reform debate progresses, the impact of reform on individual states will vary based on their economic situation, current health insurance coverage, and health care expenditures. This analysis pulls together key information related to state variation, including:
- Economic Profile: poverty rate, major industry types, unemployment rates and budget shortfalls (Figure 1.3);
- Health Coverage of the Non-Elderly Population (Figure 2.3);
- The Uninsured (Figure 3.3 & Figure 3.4);
- Medicaid and CHIP Eligibility and Enrollment (Figure 4.3 & Figure 4.4);
- Medicaid Spending and Financing: Federal Matching Assistance Rates (FMAP) for 2009, state funding, and payments per enrollee (Figure 5.3 & Figure 5.4);
- Medicaid Spending by Service and Population (Figure 6.3);
- Access to Health Care: safety net delivery sites, workforce shortages, unmet health care need, managed care enrollment and provider payment rates (Figure 7.5);
- Health Care Costs: total expenditures, Medicare expenditures and average family premium costs (Figure 8.3); and
- Individual and Small-Group Markets: guaranteed issue and rating restrictions by the individual and small group markets, as well as enrollment in high risk pools (Figure 9.3).
Health reform initiatives will have differential effects on states. In general, states with more extensive poverty, higher budget shortfalls, lower eligibility levels for public programs, higher rates of uninsured, and more primary care shortages, will be more heavily impacted.
Download PDF of State Variation and Health Reform (3 MB) 
View related interactive maps and tables and create customized health reform fact sheets on statehealthfacts.org. For additional related Kaiser resources, please visit healthreform.kff.org.
