States, municipalities take on growing uninsured issue

Throughout 2006, numerous states and municipalities continued to grapple with the growing uninsured problem by considering and, in some cases, approving legislation aimed at expanding access to health care coverage.

Though some measures made it out of their respective legislative bodies, only few actually became law, while the more controversial proposals succumbed to either gubernatorial or mayoral vetoes or court challenges.

In April, Massachusetts enacted what is widely considered landmark health care legislation. The law will provide state health insurance premium subsidies for lower-income individuals, establish a program to make it easier for employers and individuals to obtain insurance, and require residents to obtain insurance or face significant financial penalties—making Massachusetts the first state to impose an individual mandate.

Other surviving laws took a limited approach to health reform, such as those approved in Vermont and Tennessee.

Vermont's law expands coverage through a new insurance program sold by commercial insurers in which the state subsidizes premiums for low-income individuals. The subsidies come from increases in the cigarette tax as well as a $365 per employee annual fee on employers that do not offer health insurance and have nine or more employees.

Tennessee's law creates a program in which the state pays one-third of the total health insurance premium—estimated at about $150 a month for single coverage—for low-income employees working for small employers, initially those with 25 or fewer workers.

Meanwhile, Maryland's Fair Share for Health Care Act, which made headlines at the end of 2005 when Gov. Robert Ehrlich vetoed it and again in early 2006 when the state's legislature overrode the veto, once again is in limbo at year-end.

The fate of the measure, which would require employers with 10,000 or more employees to spend at least 8% of payroll on health benefits beginning in January 2007, hinges on the outcome of an appeal filed by Maryland's attorney general in response to a federal court ruling in July that the measure violates the Employee Retirement Income Security Act.

In the municipal realm, a mandate passed last summer by San Francisco also faces an ERISA challenge filed by the Golden Gate Restaurant Assn. The city ordinance, slated to take effect July 1, 2007, would require employers with 50 or more employees to pay a fee for each hour that an employee works into a fund to be used to cover the cost of their health care.

Meanwhile, Chicago Mayor Richard M. Daley struck down the city's so-called "big box" ordinance, which would have required retailers with at least 90,000 square feet of space in a single location to pay their employees at least $10 an hour and provide another $3 an hour in benefits by 2010.

And in California, Gov. Arnold Schwarzenegger vetoed two pieces of legislation: a bill similar to Maryland's and a more radical measure that would have created a single-payer system.