Insure or else: Who should pay for uninsured workers?

States and employers are trying to toss health care costs to each other, with legislative battles over who should be responsible for providing health insurance.

By Larry Stevens, AMNews correspondent. Aug. 1, 2005.

More than 30 years ago, Hawaii faced a growing uninsured population and became the nation's first state to require companies to provide health insurance for employees working 20 or more hours a week.

A few states tried employer mandate bills that failed in the 1990s.

But now, with 45 million uninsured Americans draining state financial resources, more states than ever before are looking to pass laws that would shift the cost of those lacking insurance away from state Medicaid programs and onto employers.

At least 31 state legislatures are entertaining -- or have already entertained -- bills this year that would try to coerce, encourage or even shame companies into providing coverage for their workers, according to the HR Policy Assn., a public policy organization of senior human resources executives of the largest U.S. employers.

At least 11 of those would mandate larger companies to provide insurance.

States see the measures -- sometimes referred to as "Wal-Mart bills" because some states have found that a number of the retail chain's employees are on Medicaid -- as a way to reduce the health care costs that have contributed to budget woes.

"Legislatures are trying to figure out how to balance their budgets, and they see Medicaid as a major piece of the pie," said Laura Tobler, health care analyst for the National Conference of State Legislatures.

Federal lawmakers are in on the action as well. Sens. Edward Kennedy (D, Mass.) and John Corzine (D, N.J.) in June introduced the Health Care Accountability Act, which would require states to report the number of workers at large companies who receive health coverage through taxpayer-funded health care programs.