October 10, 2007 / 4:32 PM / 12 years ago

Most states expanding health programs for the poor

WASHINGTON (Reuters) - With 47 million Americans now lacking health insurance, most U.S. states plan to expand coverage of lower-income uninsured people next year, a prominent health-care group reported on Wednesday.

Type 1 diabetic Tamara Khachatoorian, 26, injects herself with insulin at the J.W.C.H. safety-net clinic in the center of skid row in downtown Los Angeles, July 30, 2007. REUTERS/Lucy Nicholson

The Kaiser Commission on Medicaid and the Uninsured survey found that after several years of cost-containment measures, 42 states reported plans to cover more people this year and next. More than 9 million of the uninsured are children.

The survey found that Medicaid enrollment had declined slightly in 2007 for the first time in a decade, largely because of new federal rules for how people must document their citizenship. State officials said most of the people whose enrollment was delayed were poor children who were in fact U.S. citizens.

State plans to enhance coverage depend partly on the State Children’s Health Insurance Program (SCHIP). President George W. Bush last week vetoed a bipartisan plan to renew and expand the children’s plan, and the outcome of the fight is unclear.

Medicaid is a $300 billion combined federal-state health insurance program for 58 million poor people, including low-income children and patients in nursing homes.

After elementary and secondary education, Medicaid is the biggest item in most state budgets. For much of the last decade states focused on trimming spending but now with a healthier financial picture many states have begun grappling with the huge numbers of people living without health insurance.

Health care is becoming a dominant theme in the 2008 presidential race, particularly for Democrats. States have begun to step in where the federal government has not acted.

The federal framework places some limits on how far Medicaid and SCHIP can be expanded, so these two programs will not make a huge dent in the ranks of the uninsured. But they can be elements in larger programs, such as Massachusetts’ drive for universal coverage.

“There are states thinking big thoughts,” said Vernon Smith, a co-author of the report.

The Kaiser survey found that at least 42 states planned on expanding coverage, and for the first time in five years no states planned benefit cuts. Several states had, or planned to shortly, raise payments to health-care providers to help ensure that people could get the treatment they need.

States reported considering such steps as raising income eligibility levels, or covering new populations such as older adolescents or young adults leaving foster care.

They are also increasingly linking quality to payments, forcing health plans taking part in Medicaid to provide more information on their performance, a trend also seen in the private sector.

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