One of the biggest challenges facing the 110th Congress is finding the cure for one of the country’s peskiest chronic ailments – the lack of health coverage for all its citizens.

With a staggering 45 million Americans uninsured, the controversial topic of universal health care will shape Capitol Hill’s political agenda for months to come. And, with the 2008 presidential race on the near horizon, this hot-button issue will likely spark and fuel heated debates on the campaign trails as well.

“Medical costs are hitting every part of this nation like a wrecking ball,” said Sen. Ron Wyden, D-OR, a member of the Senate Finance Committee. “Getting this on the presidential agenda so that candidates of both political parties have got to get beyond position papers, is an especially important point.”

As Democrats take control of the House and Senate, a new approach to the health insurance reform is in the charts. “We have to find a way to lower rates to make health care more accessible for every American,” said Luis Miranda, a spokesman for the Democratic National Committee.

This is not just political braggadocio. Democrats plan to introduce health care legislation soon after the new session is gaveled in on January 4th, and pass it within the first 100 legislative hours. And Wyden already unveiled his  “Healthy Americans Act,” that would provide quality care for all those not covered by Medicare or military benefits. The plan would require employers to give up current premiums and convert subsequent savings into salary increases over a two-year transition period. Workers would then buy insurance coverage from private plans, with employers chipping in up to 25% of the average premium.

“The fact that the Democrats are going to take over the House and Senate,” said Gary Claxton, vice president of the Kaiser Family Foundation, “has people at least thinking there will be broader talk about health reform that doesn’t include the words ‘health savings accounts.’”

Claxton’s reference was to President Bush’s proposed “health savings accounts,” which the administration touts as an “affordable and accessible” way to encourage families to buy into health plans that might cost more at the onset, but would be compensated for in tax breaks. More than 3 million accounts are now open; many health care advocates claim, however, that the plan is not a cure-all, but it merely provides another tax shelter for the wealthy, while barring healthcare access to people with fewer financial resources.

Despite the renewed political eagerness to solve the medical coverage crisis as a matter of priority – the first such concerted effort since the Clinton administration — most Capitol Hill observers agree that policymakers in Washington will not pass universal health care legislation anytime soon. The buzz on the Hill is that states, not the federal government, will lead the way to health reforms.
In Massachusetts, for example, the state plan requires all residents to purchase some kind of insurance policy by July 1, 2007 or risk tax penalties. Business owners with 11 or more employees must provide coverage, or pay $295 annually per worker into a state fund that will then subsidize coverage for those who can’t afford it.

“What happened in Massachusetts seems to be something that’s stimulating other people,” Claxton noted.

Other states are also hammering out proposals and health reform packages ranging from purely conceptual to detailed. “The flurry of activity at the moment seems to be happening at the state level,” said Katherine Swartz, professor of health policy and management at Harvard University’s School of Public Health. “More than 20 states are now actively involved in trying to do something to reduce premiums and make health care more accessible.”

While bringing health care within everyone’s reach is the common goal, the current debate centers around who should bankroll it– the government or employers. Arguments against government-sponsored plans include tax increases, bureaucracy, poorer quality of care, and longer waits for medical procedures. But plans paid for exclusively by employers do not seem viable either because of the financial strain on smaller businesses. A 2005 survey by the Kaiser Family Foundation and Health Research & Education Trust shows that employer-sponsored health insurance is becoming scarcer and more costly, and the number of businesses still providing health benefits to employees is dropping. 

While the opinions on treatment options for one of America’s gravest maladies vary, nearly everyone agrees on the diagnosis:  the health care system needs intensive care – STAT.