ABSTRACT
State-level experimentation in the health care arena has been the subject of much recent attention in the United States. Essentially, state-level health care reform has involved different types and degrees of insurance regulation; various extensions of the scope of coverage for low-income individuals, including expansions of Medicaid; and various mechanisms of cost control within these structures, with a strong emphasis on the use of managed care. No state, through any method, has achieved universal coverage. The chapter outlines the scope and limits of state health care reform along each of the dimensions noted: Insurance reform, expansion of coverage to low-income beneficiaries, and cost control. The “policy legacy” explanation for the limited range of state-level experimentation in US health care policy holds that developments in one era led to constraints governing developments in the era to follow.
