Comprehensive health care reform returns to the states

On November 5, 2002, Oregon voters soundly defeated a ballot initiative to create a single-payer health care system. Despite the fact that Measure 23 got support from only 21% of the Oregon voters, the Oregon vote signals not the end but the beginning of a period of renewed attention to health care reform in the states. The same weak economy pushing workers from employer-sponsored plans into the ranks of the uninsured has also evaporated state revenues that had been used in the past to expand health coverage. Unable to expand coverage themselves, states are looking for ways to encourage (or require) employers to provide coverage at the same time as rapidly rising health insurance premiums are putting coverage beyond the reach of many individuals and small businesses that already had it. Citizen initiatives on comprehensive reform - promoting either a single-payor or employer mandate approach - are likely to heat up as the 2004 elections near and the public becomes increasingly incensed with losses of coverage and hikes in cost sharing. The stage appears set for another round of state level proposals - in legislatures and out - for comprehensive health care reform.