Stateline.org reported the national economy is making it difficult for states to follow the lead of Massachusetts, which last year became the first state to require that nearly all residents have health coverage.

The Web site reported that before the economy began to sour, governors in California, Illinois and Pennsylvania sought universal healthcare initiatives.

Massachusetts Gov. Deval Patrick said federal policies could undermine the Bay State's effort to become the first to establish universal health coverage.

"Our success depends on the stability and reliability of the commitments the federal government has made to us. Any retreat in those commitments could have devastating effects on our progress," Patrick told a congressional panel Feb. 26.

Eighteen states must cut a total of $14 billion to keep this year's budgets in balance, and 18 states already know they face being a total of $32 billion short in the 2009 fiscal year, according to the National Governors Association.