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1
State
of the
StateS
 
State
of the
StateS
 
January 2009
Chig  Cus:
Preparing for the Future,Learning from the Past
 
State
of the
StateS
Abu SCI
 The State Coverage Initiatives (SCI) program providestimely, eperience-based information and assistanceto state leaders in order to help them move healthcare reform forward at the state level. SCI offers anintegrated array of policy and technical assistanceservices and products to help state leaders withcoverage epansion efforts as well as with broaderhealth care reform. Our team of policy eperts tailorsits approach to meeting state decision makers’ needs
within the context of each state’s unique scal and
political environment. SCI is a national program of the Robert Wood Johnson Foundation administeredby AcademyHealth. For more information about SCI,please visit our Web site www.statecoverage.org.
S Cg Iiiis Pgm Sff
Enrique Martinez-Vidal, DirectorIsabel Friedenzohn, Deputy DirectorShelly Ten Napel, Senior Associate Anne Bulchis, AssociateColin McGlynn, Program Coordinator
State
of the
StateS
 
3
State
of the
StateS
4
 
Eecutive Summary
6
 
Surveying the Landscape
14
 
State and National Health Care Reform: A Case for Federalism
20
 
Lessons Learned from State Reform Efforts
26
 
State Coverage Strategies: Evolving with Time and Effort
28
State Coverage Strategies: Success Varies; Vision Remains
 46
 
SCHIP Moves Forward in the Face of Uncertainty
48
State Reform Efforts Target Small Employers
54
 
Cost Containment and Quality Improvement Prioritized by States
60
 
Looking Forward
61
Endnotes
Wrien By:
Shelly Ten Napel, Anne Bulchis, Margaret Trinity, Enrique Martinez-Vidal,Colin McGlynn and Isabel Friedenzohn
Manain Edir:
Shelly Ten Napel
Cnribuin Edirs:
Enrique Martinez-Vidal, Isabel Friedenzohn, Anne Bulchis,and Kristin Rosengren
Exernal Reiewers:
Bob Carey, Deb Faulkner, Barb Langner, and Scott Leitz
Ar Direcin:
Ed Brown
 table o contents
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