The federal government should join his home state of Massachusetts in enacting universal health coverage, says Sen. Edward Kennedy, the new chairman of the Senate committee with jurisdiction over numerous health issues.

Massachusetts is the first state to require everyone to have health insurance, just as drivers must have automobile coverage.

Kennedy has his own version of what universal health coverage would look like. He wants to extend Medicare to all. But, in prepared remarks for a hearing scheduled Wednesday, he signaled an intent to consider programs being tried in the states.

He particularly emphasized how Democratic legislators in his home state worked last year with Republican Gov. Mitt Romney in crafting universal coverage there.

The state of Massachusetts employs a combination of subsidies and penalties to make the insurance more affordable and to force people to buy it.

California Gov. Arnold Schwarzenegger this week proposed a plan that would extend health care to 6.5 million uninsured Californians. Under the proposal, all Californians must have insurance, although the poorest would be subsidized.

"Members of the House and Senate have a guaranteed health plan for ourselves and our families," Kennedy said in his prepared remarks. "It's time to provide the same guarantee for every man, woman and child in the nation."

The Massachusetts Democrat said too many trends in health care are going in the wrong direction.

"Insurance coverage is down. Costs are up. And America is heading to the bottom of the league of major nations in important measures of the quality of care," he said.

Advocacy groups say they're optimistic that Congress this year will expand health insurance coverage to more Americans. They are particularly lobbying to increase funding for coverage of children living in families that make too much to qualify for Medicaid, but not enough to afford the monthly health insurance premiums offered through the private sector.

However, Kennedy is talking about taking the expansion to a much higher as he becomes chairman of the Senate Health, Education, Labor and Pensions Committee.

Some of the committee's Republicans would like the committee to renew its attention on help for small businesses. They support a plan that would let businesses buy insurance through regional or national trade associations. The insurance would be free of many state mandates. That could make it a cheaper alternative, but would also provide scaled-back coverage in some instances.

"My primary interest is to provide health insurance reform for small businesses and working families, and I believe that 1 million more people will be insured if we enacted the (small business health plans)," said Sen. Mike Enzi, R-Wyo.

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