We first read about Congressman Steve Kagen’s insurance status on the Wall Street Journal Health Blog, which pointed to this article in the Scientific American. Apparently, Rep. Kagen, a Wisconsin physician who joined the U.S. House of Representatives last year, got funny looks from the human resources department when he turned down the congressional health care plan. “I’ll respectfully decline until you can make that same offer for all of my constituents,” he told SciAm of the conversation.

The article comes now that Kagen has paired his insurance abstinence with a bill – the No Discrimination in Health Insurance Act – which would require insurers to disclose rates and make it illegal to refuse coverage for pre-existing conditions.  Kagen’s proposal isn’t a comprehensive measure, but it’s also cost-neutral.

And that’s just one guy’s strategy –- okay, a guy who gets to vote on declarations of war and budget appropriations — but there are others.  There is the McCain un-Strategy, the Democratic candidates’ proposals, and Ron Wyden’s Healthy Americans Act, which has captured the attention of a bunch of folks on the Hill, and the hearts of an eager army of health bloggers.  And then there are the states, where some say the lion’s share of coverage and reform work is happening.

Consumer Voices for Coverage is one such effort to coordinate those state-level efforts among health care consumer advocates and ensure consumers have a voice in the health care debate.  Being steered by RxP parent group Community Catalyst and funded by a grant from the Robert Wood Johnson Foundation, CVC is a 12-state initiative based on the idea that consumer coalitions can move states at the tipping point of health reform by sharing resources, strategies, and experience. As this Health Affairs paper demonstrates, efforts vary widely among states, and budgetary constraints that don’t bind the feds – say, balancing the budget each year – limit the scope and practicality of cost-positive solutions in the states. And there are many states where health reform isn’t even close.  So attention to the coverage deficit at the federal level – whether it’s Kagen’s version or Wyden’s – is a good thing, and will most certainly move the needle.   Some HealthBlog commenteers point out that if Kagen does fall ill, he’ll probably get customary free care from a fellow physician – and that even un-physicians are eligible for free care, which contributes to higher rates for the insured.

Then again, no one said Kagen’s refusing insurance would solve the coverage crisis in America. But in a choice-happy climate, it’s good to see someone choosing solidarity with the people he represents.