A different kind of health care debate is emerging in the states. Instead of fostering the familiar rounds of government and business butting heads over how much health care employers must provide–and pay for–some legislatures are trying to shift the burden to the employee.

In a trend that mirrors proposals from the Bush administration at the national level, many states are considering applying the “ownership society” concept to health care. They are weighing laws that would require workers to obtain health care coverage, just like drivers must have auto insurance.

While none of these proposals has a lock on passage this year, they do represent an attempt to change the increasingly tense political atmosphere.

State legislatures have passed more and more mandates dictating what services and practices must be paid for by providers, raising costs for providers, for employers and–say many employer organizations–for employees as well through higher premiums. Employer and business groups have fought back.

Case in point: the 2004 California referendum on SB 2, the state law that would have forced most employers to provide health coverage to every worker. After a bitter campaign in which employer and business groups claimed that many companies would be forced to leave the state or go out of business, state voters narrowly overturned the law in November, handing a stinging defeat to organizations and legislators who had backed SB 2.

A variety of proposals have surfaced in California and other states, which are not satisfied to wait for the federal government to take the lead in solving the health care funding crisis. Under one California proposal, individuals would be responsible for obtaining coverage from their employers or other sources, with the state government subsidizing coverage for those who cannot afford to purchase it.

A different–and more radical–California bill would create a single-payer program in which the state government would take over the entire health care system. Assuming health care providers would be willing to hand over their business to a bureaucracy, the system would have a funding edge through streamlined operations, backers say.