As states face another economic downturn and growing budget deficits, expanding access to coverage may seem like an impossible goal.  However, there are steps states can take to generate revenue and "stretch" health care dollars to ensure access to health care.  These include using existing tobacco-settlement dollars dolely for health care, instituting employer pay-or-play requirements, improving prescription drug purchasing, improving chronic care management, and ending corporate tax loopholes.

Bringing Medicaid and SCHIP to more people is one of the best and most cost-effective ways to broaden access to health care coverage.  Medicaid and SCHIP bring in valuable federal dollars and frequently do not require new administrative structures.  In fact, maintaining or broadening investments in social services can help prop up an ailing economy.  Additionally, states can use their bargaining power achieved from a robust Medicaid program to negotiate better deals on health care services, like prescription drugs and durable medical equipment, and to create incentives for better quality care.