State solutions

September 25, 1991

From medical insurance to family leave policies, solutions to social issues facing the nation are coming not from Washington, but from the various states. From one point of view, that's a benefit, since it opens the way for different and creative approaches. But the larger picture is less encouraging.

Not all states have the strong leadership or the fiscal resources to address social problems effectively. Moreover, many governors across the nation are facing record deficits, exacerbated by increased mandates from Congress. These mandates -- such as expansions of entitlement programs like Medicaid -- increase the financial burdens on states, but do not bring with them any new financial resources to meet the cost.

A dozen or so states have passed laws requiring businesses to grant workers unpaid family leave for birth, adoption or medical emergencies, and states like Maryland are beginning serious discussions of solutions to providing health insurance to people who have no health care coverage. Even so, if social issues are left entirely to the states, the country will end up with a patchwork of policies -- resulting in some grave inequities.

For instance, suppose Maryland adopts a plan for basic insurance coverage such as the one now being prepared by state Sen. Paula Hollinger. Many Marylanders will be much better off than they are now. But that does nothing for people with no insurance in Mississippi or Utah or Montana. Medical insurance can -- and often does -- spell the difference between life and death. Until the federal government decides to address the problem nationally, Americans will, in essence, face a health care lottery. If they live in a state with good health care policies, they have a good chance to live; if not, they might die.

Efforts like Hollinger's to do something to address this problem deserve encouragement. But admirable efforts at the state level do not obscure the fact that truly equitable solutions to national problems will come from Washington, not from the states.

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