3 steps to wider health care

Many promises over many generations have been made on health-care reform, but Americans are sick of mere promises. The next president and Congress need to cast aside partisan differences and come up with practical solutions.

Unfortunately, because of the economic downturn, underwriting major reforms will be difficult and unlikely. "Savings" from tweaking programs are also unlikely to provide the resources to deal with the problem of access to health insurance.

But three approaches to covering at least some of the uninsured may be feasible for the next president and Congress:

Sign up everyone who qualifies for public health insurance.

Amazingly, 12 million uninsured Americans, including three-quarters of uninsured children, are already eligible for public health insurance. They simply have not been signed up because of bureaucratic failures and onerous federal requirements.

Lawmakers should simplify public-insurance enrollment procedures and cut down on administrative steps that might act as barriers to access, such as ineffective and expensive "citizen verification" procedures.

Furthermore, the federal government needs to increase funding and aggressively encourage state-level outreach programs for the eligible uninsured. Part of this effort could allow state program administrators to implement "express-lane eligibility" enrollment programs, as has been done in California. Those already registered for other public-assistance programs are rapidly enrolled in public health insurance.

Sign up everyone who qualifies for employer-provided health insurance.

More than five million uninsured Americans already qualify for health-insurance coverage through their employers. Yet, according to the Urban Institute, more than 25 percent of eligible workers have not enrolled in their employer-sponsored insurance plans.

We could drastically cut down on the number of uninsured working Americans by allowing businesses to auto-enroll employees in health insurance. Workers would not have to actively buy in, but they would be free to opt out. This is similar to the enrollment procedure for federal employees.

This kind of auto-enrollment has already proven effective in getting employees to sign up for retirement plans, particularly low-wage and young workers.

Expand access to private health coverage.

Lawmakers should extend a tax credit to small businesses to cover a substantial portion of their insurance expenses. The California Healthcare Foundation found this to be an effective means of expanding insurance access, particularly among low-wage workers. States should encourage pooling arrangements that allow small businesses to group together to purchase insurance plans.

The government also should provide targeted insurance subsidies for uninsured low-income families who are eligible for employer-sponsored insurance.

Of course, these steps would not be a panacea. But they could provide some real results. The next president can make some progress on health care by adopting these approaches that focus on patients, not politics.