Initiatives proposed at the state level for healthcare reform are likely to be key tests for new approaches that eventually could be implemented at the federal level.
"The answers states identify and implement will provide key insights for national health reform," said Enrique Martinez-Vidal, director of the state coverage initiatives program of the Robert Woods Johnson Foundation.
The organization on Friday released a report on state initiatives, using the results to chart future healthcare reform in the United States.
The study, "State of the States 2008: Rising to the Challenge," suggests that while many states made progress on healthcare reform, key factors that contribute to rising uninsurance remain unchecked.
Growing numbers of residents who don't have insurance are prompting state efforts. In addition, employer-based coverage is declining and public program funding is flat, which is greatly increasing the number of children who don't have health insurance, the report said.
State approaches to reform vary considerably, often depending on the political and fiscal situation of the states, demographic characteristics, insurance market dynamics and other economic factors.
Despite all these variables, most states are using a pragmatic approach to address healthcare reform, Martinez-Vidal said.
"A single-payer system is generally not considered a politically viable option, but neither are reforms that rely completely on a free-market, consumer-driven healthcare system," he said. "Instead, most state reforms look to politically feasible proposals that build on the current mixed public-private health insurance system."
In addition, a variety of state activities took aim at systemwide improvements in quality, care coordination and cost containment. Increasingly, states are coupling coverage expansions with strategies that target chronic conditions, wellness and prevention, the uptake of health information technology and public reporting of information on cost and quality.
With these efforts, states are working to improve quality, control costs and improve the value of public and private programs, the report said.
"We're seeing states attempt to address health reform with a balance of coverage expansions, quality improvement efforts and cost-containment strategies," said Martinez-Vidal. "They continue to take the lead in addressing the problems of the uninsured."