Single-Payer and Universal Health Care Efforts

Citizen-led efforts to institute more universal health care programs are cropping up across the country.

Some are very similar to the Canadian health care system. They call for a single-payer system, meaning that medical care would be paid for out of a single publicly administered pool of money, rather than by myriad managed care plans. In most plans the health insurance program would be administered by a health care "trust," governed by a combination of stakeholders, including health care advocates, providers, organizations and experts, taxpayer representatives, and state officials.

Providers would still charge on a fee-for-service basis, with fees determined through negotiations between these stakeholders. Patients would still have the freedom to choose their health care provider. "Medically necessary" care would be covered. Many plans have some sort of sliding premium scale, whereby the poorest residents of the state would pay no health care taxes, and the wealthiest residents would pay the most.

Here we highlight some single-payer and universal health care initiatives that have been introduced or put in place.

Local Rules:

• Health Care Program - New York, NY
  Enacted in August 2005, the New York City Health Care Security Act requires any grocery store with 35 or more employees or any retailer larger than 10,000 square feet to contribute $2.50 to $3.00 towards health care for each hour an employee works. More...
• Universal Health Care - San Francisco, CA
  The San Francisco Board of Supervisors unanimously approved the San Francisco Healthcare Access Program (SFHAP) in July 2006 with legislation entitled the San Francisco Health Care Security ordinance.   The program would give the city’s 82,000 uninsured adults access to healthcare regardless of income, immigrations status, or medical condition.  More...

State Rules:

• Single Payer Health Insurance - California
  In March 2005 the state assembly will consider the California Health Insurance Reliability Act, which would provide all state residents with full coverage of medical, dental, vision, and hospitalization services, and pharmaceutical benefits, through a statewide, single payer system. More...
• Single Payer Health Insurance - Connecticut
  Although killed in committee in early 2001, The Connecticut Health Care Security Act is a good single-payer model for other states to follow. The Act would have insured payment for all medically necessary services, medications, and long term care for all residents of the State of Connecticut. More...
• Universal Access to Health Care - Maine
  DIRIGO HEALTH is Maine's universal access to health coverage plan. The new law is a plan to provide affordable health insurance to small businesses and individuals and to control health care costs. The legislation offers a phased-in approach with an ultimate goal to ensure that all of Maine's citizens have access to health care by 2009. More...
• Universal Health Care Initiative - Massachusetts
  A bill to create the Advisory Committee on Consolidated Health Care Financing was passed and funded in the summer of 2000 as part of the compromise legislation that was drawn up as a result of the statewide ballot initiative for a universal program. It will determine financing for universal health care in Massachusetts. More...
• Health Care Constitutional Amendment - Massachusetts
  The Massachusetts legislature has taken the first step toward making health coverage a constitutional right. More...
• Universal Health Care Initiative - New Mexico
  Twenty-five percent of New Mexicans have no health insurance, one of the nation's highest rates (the national average is about 15 percent). That statistic has prompted health care advocates to introduce universal health care legislation every two years since the early 1990s. More...
• Universal Health Care Initiative - Vermont
  The Vermont Health Access Plan provides an array of health benefits to state residents, including children, low-income adults, and the elderly. More...

More:

• The Robert Wood Johnson Foundation’s provides a wide array of information on state efforts to expand coverage. Their shows what each state is doing with Medicaid, SCHIP, and state-only programs. Also look for their annual State of the States report. State Coverage InitiativesState Coverage Matrix
• The Urban Institute’s Assessing the New Federalism section has reports on state fiscal policy related to health and wellbeing, as well as state profiles of health insurance, access, and use.
• Policymakers interested in employer mandates should read the National Academy for State Health Insurance Policy’s Revisiting Pay or Play: How States Could Expand Employer-Based Coverage Within ERISA Constraints.
• A Public-Private Partnership for Health Care For All Marylanders - Maryland Citizens' Health Initiative, December 2002
  This report is a blueprint that Maryland can follow to achieve a market-based, fair, responsible, and economically sound universal health care system.
• White Paper: "Physicians' Working Group on Single - Payer National Health Insurance - by the Universal Health Care Working Group, May 2001
• The Canadian Cure - by Daniel Kraker, The New Rules, Winter 2001. This article explores how Canada's provinces established a health care system founded on equity, public administration and decentralized control.
• American Health Care Reform
• Physicians for a National Health Program
• Universal Health Care Action Network
• A primer on single payer health care and from the American Medical Student Association
• Universal Health Care Briefing to the Progressive Caucus - by The Physicians' Working Group on Single-Payer National Health Insurance, May 1, 2001