In most cases we hear about states struggling to find the funds needed for health care reform. But thanks to a large settlement from big tobacco, Washington health insurance and care services may be in for a big boost.

Washington, D.C. received a total of $245 million dollars as its share of a national settlement between tobacco companies and states. Local officials had asked the RAND corporation to conduct a study of the areas that needed the most help with Washington health insurance services, and health care in general.

According to the article at Kaiser's Daily Health Policy Report, RAND suggests that Washington, D.C. should spend $90 million of the funds on "services provided by community health centers in the district's underserved areas," allowing for better health care for those people who can't afford Washington health insurance, or who are too underinsured to enjoy decent care.

Another $24 million was recommended for improving electronic health records, and $7.5 million for mental and oral health issues, as well as numerous smaller projects.

While Mayor Adrian Fenty hasn't been concrete about how and where the funds will ultimately go, should he follow RAND's suggestions, those people who need Washington health insurance may be in for a treat when they discover that their state has provided for them and for their health care.

The last time California health insurance was in the news, it was due to Governor Arnold Schwarzenegger's attempts to establish a universal health care system, attempts that ultimately failed to pass into law.

But now, Schwarzenegger's ties to California health insurance seem to have reversed themselves, as he seeks to cut $1.1 billion from the state's spending on Medi-Cal (California's Medicaid program).

As it's reported by Kaiser's Daily Health Policy Reports, the same health care groups that once supported Schwarzenegger's $15 billion health coverage expansion plan have now banded together into a coalition to protest his proposed budget for fiscal year 2009.

One of the ways that he plans to fill the $17 billion dollar budgetary hole facing the state is to cut back on Medicare spending, a move that critics argue will lead to 1 million more uninsured people in the state, bringing the total to "7.5 million over three years."

The governor's office argues that the budget reflects what a difficult year is facing California right now, and that Schwarzenegger is still dedicated to a California health insurance plan that offers affordable coverage to all state citizens.

We know that being poor means you'll be unlikely to afford good access to medical insurance, but what do you do if your state and your employer don't offer employees access to good group health insurance coverage either?

You hope you don't get sick or injured, that's what you do.

According to a study released at MSN Health, the Southwest ranks lowest in terms of access to health care. Why? Mostly because many jobs in the Southwest are service or construction jobs (or others) that don't offer employees the benefit of enrolling in a group health insurance plan.

The majority of Americans with access to good health care today have it because their employers have enrolled them in a group health insurance plan. Group health insurance rates are often much lower because insurance companies take in more money than they spend - in other words, everyone is paying, but only a couple are bound to get sick or hurt. Therefore, rates can be lower.

But in some workplaces employers don't offer these services, and in the Southwest state legislation that would protect these workers hasn't been enacted.

The result is that people in these states are less likely to get checkups, and spend more time and money in the emergency room when something does go wrong.

In the long run, this costs everyone, since medical debt filters down into medical insurance premiums that we all pay. So the truth is, no matter what kind of coverage you have, we're all paying for the fact that some hard working Americans aren't getting the insurance coverage they need.

Since Massachusetts made moves to restructure a more affordable health insurance system, and then made it the law to have coverage, the rest of the country has watched to see if this one state could provide the blueprint for universal coverage nationwide.

According to Kaiser's Daily Health Policy Report, they're off to a good start. The moves they've made towards affordable health insurance have led to more enrollment than had previously been projected this early in the year. Furthermore, other concerns - like the fear that people could drop private plans to obtain subsidized coverage and that businesses could eliminate insurance plans for employees - haven't appeared.

But Massachusetts isn't off the hook yet. The article suggests that though affordable health insurance is out there, 350,000 state citizens still haven't picked up coverage. The "real test" will come when those people face stiff penalties, and the state will find out whether "coverage can really be made mandatory without sparking political resistance."

Of course, there are costs to worry about too. A new cigarette tax is being considered to off put the higher-than-expected costs of providing affordable health insurance to everyone. But, if Massachusetts handles it well, they could provide the rest of the country with a clear path to universal health care.

Now that Hillary Clinton has officially conceded the race to Democratic nominee Barack Obama, the fate of affordable health insurance seems to be up in the air.

Clinton's platform was prominently supported by her assertion that should she be elected president, not only would affordable health insurance become a reality for all Americans, all Americans would be required to have coverage.

This would have theoretically provided coverage to most of the almost 50 million Americans out there without insurance, as well as minimized the burden of growing medical debt on hospitals and consumers.

Detractors argued that the country couldn't afford to offer such a plan.

But now, according to Kaiser's Daily Health Policy Report, the fate of mandatory, affordable health insurance is sealed. Neither candidate running for the fall believes in health care mandates, with the exception of children's health care as supported by Barack Obama.

Other setbacks to the mandatory health care plan include the failure of a similar plan to pass in California, though Massachusetts is seeing growing improvements in the mandate they enacted just this year.

But among other basic needs like gas and food, health insurance prices are still growing out of control. Hopefully whoever wins the election in November will take steps to make affordable health insurance available to more Americans, even if it isn't required by law to purchase it.

Now that his role as the presumptive Democratic nominee has begun to sink in for most Americans, Barack Obama's health insurance plans are becoming the subject of criticism for those who feel that he doesn't embrace enough change when it comes to our health care system.

The recent article at the Seattle Times features just such criticism. Obama's health insurance views are compared to Republican nominee John McCain's ideas on the subject, and neither one comes out appearing especially useful.

Both candidates promise to make health insurance more affordable for all Americans, both making arguments relying on tax credits and incentives, as well as subsidizing care for those who can't afford it.

Obama's main departure is that he advocates universal health insurance for children, a move that is popular, but perceived as being too limited by those who favor madatory coverage for all Americans.

But with health care occupying the position as third most important topic for Americans - behind the economy and the war in Iraq - it's probable both candidates will do a better job of detailing their positions on the topic in the months leading up to November elections.

While most state citizens have been positive about the creation of mandatory universal health insurance in Massachusetts one group, small business owners, have been concerned that group health insurance costs will be too expensive for them to offer coverage to all their employees.

Many employers can't afford to offer group health insurance policies to their workers, because Massachusetts health plans have risen at least 10% in the last seven years.

According to the article at Boston.com, Massachusetts' per capita spending on health care is among the highest of any state in the country, a fact that's been putting the squeeze on business owners.

In an effort to balance out the costs of a more extensive state health insurance plan, and the burden of high group health insurance costs on business owners, the Coalition for Affordable Health Care said it will work to control the size of the contributions applied to employers, and prevent a large portion of the expenses from being shifted to small business owners.

We've all heard lately of the struggle to cover those people with pre-existing conditions under individual health insurance plans. However, what's defined as a "pre-existing condition" is sometimes an issue of its own.

At the New York Times it's revealed that women who have had a caesarean birth are considered by some individual health insurance agencies to have a pre-existing condition, since it's likely that they will have another such delivery should they become pregnant again.

The argument from the insurance agencies is that more and more women are having caesareans, and they cost more than regular deliveries. And further, hospitals often prefer to schedule a second caesarean in order to minimize the likelihood of a rare but fatal complication, uterine rupture.

But women argue that in most cases they haven't selected a caesarean birth, and would prefer to deliver naturally in a second birth. They feel it isn't fair for individual health insurance agencies to treat them as if they have an illness or disease.

Of course, not all health insurance agencies treat caesarians in this way. However, it's important for any woman who might have children, and who has, or will be searching for, individual health insurance to ask about their coverage for caesareans. This could allow the women to avoid elective caesareans in order to minimize costs, and to find the insurance agencies that best suit their needs.