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A Massachusetts Republican aims for 'universal healthcare'

Mitt Romney wants to expand insurance coverage using incentives rather than government spending. Can it work?

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The Republican governor of one of the nation's most solidly Democratic states says he can succeed where others have failed: moving toward truly universal access to affordable health insurance.

For Gov. Mitt Romney (R) of Massachusetts, it's a high-stakes gambit to resolve what has become a gut-level concern for millions of families nationwide in an era of rising healthcare costs.

If successful, his effort could not only expand healthcare to more Bay State citizens but point a path for other states, and possibly the federal government. If the plan moves forward but fails to show results, it could deal a setback to the broader Republican Party message that Romney espouses: that incentives and free-market economics, more than government programs, can resolve US healthcare woes.

In the end, the effort here may founder as others have nationwide in recent years. But the urgency of the problem, Romney's credentials as a rising political star, and the desire of Bay State Democrats to expand healthcare all suggest the possibility of at least an interesting experiment.

"No one has come up with an effective and politically feasible solution. It is the ongoing struggle at the state level," says Michael Sparer, a health policy expert at Columbia University in New York. The attraction to be the one to find the answer is undeniable "when you combine that [it is] an area where an ambitious politician might make a real difference with the reality that there is a crisis out there."

Healthcare is a subject that governors can hardly ignore. For the first time, Medicaid expenses this year represented a larger share of state budgets than K-12 education. And the number of uninsured has been rising - 25 percent in Massachusetts since 2000, for example. And with observers speculating that Romney may make a 2008 presidential bid, this is an issue that can build political credentials.

States have diverged in recent years in their approaches to healthcare. In Massachusetts, Romney recently proposed "Commonwealth Care," which would urge insurers to offer less expensive basic healthcare plans. It would also seek to increase Medicaid enrollment, target those fraudulently enrolled in the program, and potentially penalize small companies that deny employees coverage, though it would not compel employers to provide insurance. Romney says no additional state spending should be required.

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