Can States Lead the Way to Universal Coverage? The Effect of Health-Care Reform on the Uninsured

Objective. This study assesses the impact of state policy reforms on health insurance coverage in the U.S. states considering three approaches to reform: consumer protection policies, policies relaxing regulation on insurance companies, and policies expanding public benefits. Methods. Using data collected from several publicly available sources, we estimate state insurance coverage using fixed-effects pooled time-series regression from 1992 to 2005. Results. We find that the only policies that had a positive effect on coverage were those expanding public benefits. None of the other state policy measures were associated with increased coverage and pricing restrictions actually were associated with reduced coverage. Conclusion. We argue that a federal-state partnership offers an imperfect short-term strategy but that in the long run, states are incapable of assuming the burden of fully covering the uninsured.