When Oklahoma Insurance Commissioner Kim Holland entertained the prospect of penalizing state residents who fail to buy health insurance, the local media criticized the punitive approach.
Possible penalties like the forfeiture of college football tickets and lottery winnings created a huge public uproar, but Holland said that she's "excited" because the incident "raised the issue of the uninsured to a level of dialogue that didn't exist before."
Oklahoma has been working on its State Coverage Initiative for nearly two years, and though multi-stakeholders have been consulted, the public hasn't been as involved as it could be, Holland said. Seventeen percent of the state's population is uninsured.
The average yearly premium for an insurance plan is between $14,000 and $15,000, which makes coverage unattainable for many who live at 200 percent of the federal poverty level.
"The most critical issue we face is to make healthcare coverage more affordable," Holland said.
Oklahoma is a conservative state, so an insurance mandate is highly unlikely, but Holland believes that a voluntary system won't work either. She said everyone needs to understand the consequences of not having insurance, as well as the appropriate incentives or inducements.
The state of Texas also has no penalties or incentives for lack of health insurance, said John Greeley, public information officer for the Texas Department of Insurance. Texas is addressing its uninsured problem - currently in the mid to high 20 percent of the state's population - through its legislature.
Northeastern states are concerned about the uninsured as well.
Approximately 8 percent of Pennsylvanians are uninsured, according to a 2004 study, the most recently available. The state relies on the State Children's Health Insurance Program and a program for adults aged 19 to 64 for coverage.
While Pennsylvania currently does not penalize residents for being uninsured, a mandate for coverage is just one of the issues being discussed by the Insurance Commissioner and Governor Ed Rendell, said Katherine Gresh, spokeswoman for the Pennsylvania Insurance Department.
Marshall McKnight, spokesman for the New Jersey Department of Banking and Insurance, or DOBI, said his state is striving to make healthcare insurance more affordable and available, "rather than take a punitive approach."
In January DOBI began implementing Senate Bill 1557, which will expand NJ FamilyCare, establish a mandate for healthcare coverage of children and create reforms.
"These reforms make the individual and small employer insurance markets more affordable and should increase the number of insured in New Jersey, which has been on the increase over the last several years," McKnight said.