Don't look to the states to make a sizable dent in the nation's uninsured population. They don't have the means or the muscle.
So argued a study in the Aug. 13 Journal of the American Medical Association. Assuming healthcare reform on the federal level will move ahead incrementally, the authors considered how likely individual states are to reduce their numbers of uninsured people.
The article by researchers at Rand Corp., based in Santa Monica, Calif., divided the country into four groups of states, depending on the percent of uninsured residents.
It turned out the states with the worst health insurance rates were also those with the least ability to raise money to subsidize health insurance for their low-income residents. Conversely, those states with good health insurance coverage were those that enjoy the per-capita income to raise taxes to cover the uninsured.
Without federal intervention, the situation is a stalemate, the study said. The best way to rectify it may be to target federal block grants to those states that have the least taxing capacity, and let them design the program that best meets their needs.
On average, the wealthier Rust Belt states with low rates of uninsured would have to increase per-capita income taxes by $130 per year to cover their uninsured. The poorer states, those with higher uninsured rates and arrayed across the Sun Belt, would have to raise per-capita income taxes by $230 to achieve the same result. That, the authors said, isn't very likely.
They concluded: "We think targeted federal financial assistance beyond current levels is a necessary condition, if state health system reform is to be relied on as the chosen vehicle for a drive toward universal coverage."