Despite the success states have had increasing health care coverage, national health care overhaul must address costs to be sustainable, lawmakers and witnesses said at a Senate Health, Education, Labor and Pensions Committee hearing.

"Our current pace of spending is not sustainable and we must get health care costs under control," Ranking Republican Sen. Michael B. Enzi of Wyoming said at Tuesday’s hearing.

"Near universal coverage is simply not sustainable financially unless we address health care costs," said Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector in Boston, Mass.

In spite of the financial burden, Kingsdale said the state’s individual mandate has been essential to covering a large portion of uninsured Americans in Massachusetts. The state now has 97.4 percent coverage, Kingsdale said, compared with a national average below 85 percent. In addition, the mandate has not exacerbated health care costs in Massachusetts, but simply has not solved those problems, Kingsdale said.

Eileen McAnneny, senior vice president of Associated Industries of Massachusetts, also said that much of Massachusetts’ success in reducing the number of uninsured stems from the individual mandate. Many of the 432,000 newly insured Massachusetts residents had access to health care before the 2006 overhaul, but chose not to enroll, she said.

Nevertheless, McAnneny said the high cost of health care is a barrier to purchasing health insurance for many small businesses and individuals and must be addressed.

"In Massachusetts we tacked coverage first," McAnneny said.  "Employers would have preferred the containment issue."

The state of Vermont, in contrast, did not implement an individual mandate for in their state’s health care overhaul.

"We had to think, can we provide affordable comprehensive coverage that people have access to and can we afford it?" said Susan Besio, director of the Office of Vermont Health Access for Vermont’s Human Services Agency.  "No… not in this economy."

Witnesses from Vermont also said the headway that states have already made in addressing health care overhaul should be considered when designing national health care legislation.

"As you go forward, please be careful that your efforts do not undermine what we have done in the states," Harry Chen, a Vermont emergency room physician, said to the committee.

David Clark, Speaker of the Utah House of Representatives, said lawmakers should ensure they do not take any action that will limit the states’ abilities to develop creative solutions to health care.  But there are certain elements of health care overhaul that can be applied across states, he said.

"If two states with such widely differing cultural, political and systemic backgrounds as Utah and Massachusetts can pursue similar reforms, then other states can do that same," Clark said.

Clark and Brent C. James, executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare in Salt Lake City, Utah, also said the biggest obstacle to health care overhaul is the cost of implementation.

"It is truly a very, very costly process to go through," Clark said.

Witnesses also discussed the barriers that contributed to California’s recent failed health care overhaul effort. Controversy over an individual mandate, an inadequate stakeholder coalition and the announcement of the state’s $14.5 billion budget deficit all played a part, said Ruth Liu, senior director of health policy and health reform for Kaiser Permanente California.

Yet Consumer Watchdog, a California-based organization that advocates for consumers, said California’s health overhaul effort and Massachusetts’ budget overruns can be attributed to a lack of cost control in state overhaul proposals.

"Pushing for expanded health coverage while ignoring soaring health care costs killed health reform in California and threatens the sustainability of Massachusetts’ plan," Carmen Balber, Washington Director for Consumer Watchdog, said in a news release. "National health reform must not go down the same path."

Committee Chairman Sen. Edward M. Kennedy, D-Mass., said he is optimistic about the future of national health care overhaul.

"I am very hopeful this committee will be able to deal effectively," Kennedy said.