American College of Physicians: Internal Medicine — Doctors for Adults ®


The grassroots push for universal coverage

By Phyllis Maguire

While the presidential candidates of both major parties have shied away from tackling access to health care, grassroots groups in several states are fighting to keep the issue alive. The problem is that they are running into a tough political climate and well-financed opposition.

In Massachusetts, for instance, universal coverage is part of a controversial ballot initiative that also calls for a moratorium on for-profit conversions of nonprofit health care systems and a 10% cap on health plan profits and administrative costs. The initiative ran into trouble this summer, however, when the state legislature passed a watered-down version that will create a commission to study the feasibility of universal coverage and establish a regulatory group to review for-profit conversions of health systems.

Advocates claim that lawmakers rushed legislation to a vote to derail the coalition's efforts. Several coalition members withdrew their support, saying that the legislation addressed many of their concerns. While a splinter group is still working to get the ballot initiative passed, its success is doubtful.

In Washington state, advocates have also encountered serious obstacles in their efforts to boost access to health care. They are collecting signatures to send an initiative calling for a central public trust to finance coverage for residents to the state legislature.

The first obstacle is collecting 220,000 signatures by the end of this year. "That's one in every 12 registered voters in the state," said psychiatrist Stuart J. Bramhall, MD, president of the Seattle-based group Health Care 2000, which is sponsoring the petition drive.

Dr. Bramhall explained that the group was founded in 1993 by physicians who wanted to support federal health care reform. Today, the group is pushing for state coverage to address problems like funding shortfalls in the state's hospitals and an insurance market that provides Washington consumers with very few choices.

Not surprisingly, insurers aren't supporting the group's efforts, which leads to another obstacle. Dr. Bramhall said the initiative is getting very little media coverage in urban markets because insurance companies are big advertisers.

Diane D. Lardie, national director of the Cleveland-based Universal Health Care Action Network, a national advocacy network that supports activist groups, said she isn't surprised by the stiff opposition her colleagues have received in some parts of the country. "Any time you confront a system with this amount of money involved, you're going to run into harsh political realities," she said. "This doesn't have so much to do with an understanding of solutions as it has to do with dollars and cents." (More information on Ms. Lardie's group is available on the Web at

Other groups have learned the same lesson. When advocates from New Jersey Health Care for All, for example, met a state representative in Washington to press its cause, they were surprised by what they heard. While the representative applauded their cause, he refused to publicly endorse it, claiming that universal coverage would detract from more immediate concerns like a Medicare prescription drug benefit and patients' protection bill.

The lesson to the group was clear: As long as industries that oppose health care reform continue to fund political campaigns, even liberal politicians will be reluctant to publicly support initiatives to expand access.

"They're doing their best," said John Glasel, a group spokesman, of politicians and the issue of universal coverage, "to keep it off the front page."

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