Translation of state health reforms into new federal policies

The prospect for national health reform brightened with the inauguration of a new Administration focused on expanding health coverage and the success of a number states that have implemented a range of reforms over the past several years. In light of recent economic stimulus legislation, debate has been ongoing as to whether health reform is achievable in the current economy, how consensus can be developed among uneasy stakeholders, and of what reform should consist at this time. Evaluations of enacted state reforms have informed financial negotiations between states and the federal Medicaid program, as states have sought to maintain such support. At the same time, a vibrant policy debate at the federal level is considering significant change to the federal government's role in expanding access to health coverage. Maine, Vermont, and Massachusetts represent comprehensive efforts at expanding access, while several other states have achieved reforms that include such components as prevention and wellness, private insurance market innovation, and small employer participation. A review of implemented state-level reforms will connect the policy and politics of states with reforms in progress to federal changes either under discussion in or enacted by Congress.