Families USA sponsored a conference last month entitled "Health Action", which pulled together a variety of leading lights from politics, policy, government and the private sector to discuss individual states' efforts to improve access to and coverage for health care.

Key findings include:

1. many states recognize that health care is "an unavoidable issue, and every sort of option—from limited benefit packages and mandate-free benefits to health savings accounts—is under consideration." (quote from http://pn.psychiatryonline.org/)

2. the most common program is one of "premium assistance", wherein funds from various programs and sources are "cobbled together" to provide a subsidy for individuals who then purchase health insurance from private payers.

3. fewer states are working on expansions of Medicaid and the State Children's Health Insurance Program (SCHIP) - these are much tougher to do as a result of rapidly expanding costs and the Federal government's strong desire to cut Medicaid funding.

4. some states are working on building a consensus for a more sweeping overhaul of the system; this based on the perception that although this effort will take time, piecemeal efforts are proving to be less than satisfactory.

According to Psychiatric News,

"Alan Weil, Exec. Dir of the national academy of state health policy (NASHP), said premium-assistance programs, which are the predominant approach states are taking today, are basically about building a bridge between public and private health insurance systems. They have grown up around the recognition that the majority of the uninsured are workers employed by businesses that do not offer health insurance.

So, for instance, a state may publicly subsidize the purchase of employer-provided health insurance for workers who qualify. Some contribution is also expected from either the employer or the employee, or both, Weil said.

According to the NASHP, 14 states now operate some form of premium assistance: California, Illinois, Georgia, Iowa, Massachusetts, Missouri, New Jersey, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, and Wisconsin. At least 10 other states are in the process of developing a premium-assistance program.

"The bad news is that because they are trying to cobble together different dollars from different sources, it's hard to come up with the financing to achieve a solid, comprehensive insurance policy," Weil said.

He added, however, that there is an emerging consensus among elected officials in both parties and across the country that the gap between public insurance and private insurance—where most of the uninsured fall—is ripe for action."