ABSTRACT
On September 22, 1993, President Clinton, addressing a joint session of Congress, waved a mock-up Health Security card in front of a national television audience and made an extremely well received appeal for universal health coverage. One has to go back to the Progressive Era at the beginning of the century to find a period of activist state government as strong as that of the late 1990s. Two major developments have been driving the states' involvement. One has been the ever-increasing cost of Medicaid during the past 20 years. Double-digit health care inflation produced an almost overwhelming burden on state treasuries. Each area of policy making has a largely identifiable list of players and a set of at least partly structured relationships. It is time to look at the actors in health policy and how they go about affecting what government does.
