Pros and cons of Massachusetts, Tennessee plans could get a closer look.

Lawmakers looking to revamp the U.S. healthcare system might be wise to see what's working -- and what's not -- on the state level. But attempting to implement universal healthcare can take many forms, so finding the best answer is no easy task.

“The belief that we should all have health insurance coverage is widely held,” Alan Weil of the National Academy for State Health Policy told the Minneapolis Star Tribune. “But there are tremendous differences around the country in beliefs on how to achieve that goal.”

Two examples being held up for Congressional consideration are the state health insurance programs in Massachusetts and Tennessee, the Star Tribune reports. The states took different approaches to a common problem so Congress can examine both the pros and cons of each. 

Massachusetts Opts for Wider Coverage

Massachusetts chose to offer health coverage to virtually everyone when it overhauled the state system in 2006. It set high standards for minimum health insurance and opted to deal with costs later.

Today nearly every resident in Massachusetts has health insurance, but doctors are turning away new patients, the state’s costs are rising, and thousands have paid tax penalties for being uninsured, according to the Star Tribune.

"Once you start down the moral path to universal coverage, you inevitably confront costs," said Jon Kingsdale with Massachusetts Health Connector, the agency that helps residents find healthcare. "If you get everybody covered first, it's easier to deal with the costs. If you're going to hold the uninsured hostage to containing costs, you have more than doubled the height to get up this hill."

Now that Massachusetts has conquered universal coverage, it has to improve on cost and quality, Kingsdale said in a report from North Carolina Public Radio. "Once you solve part of this very complex set of problems, you then probably exacerbate some other problems and need to focus," he said. "So that's exactly what we're doing in Massachusetts."

Coming change: Pared-down benefits may lie ahead in Massachusetts because the newly insured swelled costs of Commonwealth Care to $628 million last year, the Star Tribune reported. Soon a state commission expects to call for fundamental changes in the way doctors and hospitals are paid, a plan that amounts to putting them on a financial diet, the Star Tribune continued.

Tennessee Lives and Learns

Tennessee planners chose another route when they launched CoverTN.

The state's previous program called TennCare, "got totally out of control," Gov. Phil Bredesen told the Star Tribune. "It was growing at 15 percent a year. Tennessee had the most expensive Medicaid program in the country. Our experience with trying to do universal coverage ended up being a disaster."

CoverTN, on the other hand, moved slower, with planners choosing to get just a few more people bare-bones insurance at a budget price with limits on how much plans would pay for hospital stays. Bredesen said CoverTN takes "baby steps" toward covering more people. It targets workers at small businesses, the self-employed, and the recently unemployed. The cost of monthly premiums is shared by the state, the individual, and employers. No one is forced to participate.

Their program hasn’t cramped the state budget (partly because it’s a much smaller program), but few people (about 19,000 Tennesseans) are buying the new insurance even though premiums are as low as a monthly cell phone bill.

Mostly it's the "young invincibles" who are staying away -- the young adults who "don't feel like they're going to get sick," said Laurie Lee, who directs CoverTN and other state health benefits programs. "Older people with chronic conditions are signing up."

Be aware: Reform legislation modeled after Massachusetts’ near-universal health insurance law “is likely to emerge” in Congress, “although details remain unsettled,” the Star Tribune states. A variation of Tennessee’s practice of charging higher premiums to smokers and those who are overweight could also emerge. Lawmakers in the Senate have already discussed a lifestyle tax mechanism, such as taxes on alcohol or sugary beverages to help finance the national plan.