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COPYRIGHT 2004 Thomson Financial Inc.
The Institute of Medicine panel that's meticulously studied uninsurance and its consequences for three years says this: To save the country from a creeping coverage crisis that threatens access to care even for those with health insurance, the federal government must implement a fully fleshed-out initiative to extend continuous, personally affordable health coverage to every American by 2010.
"For the first time," the IOM has officially concluded that "small steps are inadequate" and it calls on the president and Congress to create strategies immediately to extend coverage to everyone, committee co-chair and University of Michigan President Mary Sue Coleman said at a Jan. 14 briefing on the report Insuring America's Health: Principles and Recommendations. Besides calling for a "firm and explicit" federal schedule to achieve universal coverage by 2010, the committee also wants to stem erosion of current coverage by funding Medicaid and the State Children's Health Insurance Program adequately to cover everyone now eligible and continue outreach efforts.
States must collaborate with federal efforts but can't achieve universal coverage on their own, as some hope, said Shoshanna Sofaer, professor of health-care policy at Baruch College in New York City. "Federal action, ultimately, is going to be essential." History demonstrates that states don't have the steady financing or the legal flexibility to expand coverage to all, in part because the Employee Retirement Income Security Act limits state power over insurance matters.
In an extensive review of state and local programs to expand coverage, the panel notes that, except for Tennessee, states that have undertaken significant coverage expansions with some success "have been those that could rely on relatively high levels of employment-based coverage," plus previously established...
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