Since 2003, at least three states - Maine, Vermont, and Massachusetts - and the city of San Francisco have enacted legislation with the express goal of ensuring all residents have access to health care coverage. While each has been met with varying degrees of success, and with San Francisco likely to be the first jurisdiction with true "health care for all," they have all served to spur comprehensive reform efforts across the country. States like Colorado, New Mexico, and Washington created health care commissions to design programs for "health care for all" and in 2007 Oregon lawmakers created a roadmap (SB 329 ) for developing a system that ensures health care for all state residents.
All of these initiatives, particularly those in Maine and Vermont, pursue a comprehensive approach to reform - addressing cost, quality, and access. Lawmakers and advocates in Massachusetts, who have achieved significant success by cutting the state's uninsured rate by half since 2006, are now eyeing containment of public and private health care costs as the next major push for reform. This section discusses priorities for comprehensive reform, the road to reform, and model initiatives in key states, specifically Wisconsin.
Following Massachusetts' passage of comprehensive reform in 2006, other large states became fertile ground for the health care debate, and major proposals to guarantee comprehensive reform were proposed in Pennsylvania, Illinois , and California in 2007. These bills closely followed reforms enacted in the forerunner states, including some level of individual and employer mandates, as in Massachusetts. While Governor Rendell continues to pursue his "Prescription for Pennsylvania " proposal in multiple pieces of legislation, SB 5  - Illinois Covered - fell in part to internal state house politics. Similarly, California's compromise proposal (AB1 X1 ) between Governor Schwarzenegger and legislative leaders was abruptly halted in the Senate after passing  the State Assembly, reportedly due to the state's burgeoning budget deficit. Additionally, while the California legislature has twice passed a single-payer health care measure, although without including a funding mechanism, Governor Schwarzenegger has twice vetoed it.
All of this activity bodes well for health care reform nationally and in the states, in large part because states look to each other for guidance and ideas. For instance, lawmakers in Iowa this year enacted legislation with the goal of covering all children, joining at least Illinois, Pennsylvania, Massachusetts, Washington, and New York. The legislation includes language, derived in part from the California compromise measure, which calls for the state to limit the cost of children's health care coverage to an affordable percentage of family income.
Fortunately, there are new models for reform, such as Healthy Wisconsin, which offer a new standard for states and go further than the Massachusetts model towards guaranteeing quality health care for all residents and ensuring new systems are resistant to economic ups and downs.