State Coverage Strategies: Success Varies; Vision Remains

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This year’s summary of state strategies for health reform highlights the dramatic variation that has existed among the states in 2008. Some states were attempting to enact sweeping reforms, others passed incremental changes, while still others did not have health care high on their agenda. Despite the uncertainty caused by the beginning of the economic downturn and with State Children’s Health Insurance Program (SCHIP) restrictions from the Centers for Medicare & Medicaid Services (CMS), many states were able to make progress.

Northeastern states like Maine, Massachusetts and Vermont continue to advance implementation efforts, with Massachusetts demonstrating particularly strong success in covering the uninsured and starting to focus more on tackling unsustainably high health care costs.
Other states entered 2008 with comprehensive plans for health reform, ranging from universal coverage for all state residents to system-wide reforms to address quality improvement and cost containment. California, New Mexico, Kansas, and Pennsylvania are examples of states that tried but failed to pass comprehensive health reform legislation in 2008. These states will benefit in the coming years from the statewide dialogue that the proposals have stimulated.
Iowa, Minnesota, and New Jersey passed legislation during the year that will increase coverage and, particularly in the case of Iowa and Minnesota, will move the states forward in containing health care costs and improving quality. Additionally, a handful of other states, such as Arkansas, Connecticut, Ohio, Oklahoma, Oregon and Utah, used 2008 to build consensus and create recommendations ranging from increases in coverage for specific populations to substantial system redesign.
This section categorizes state reforms in order to reflect general similarities in trends and approaches. It organizes the wide range of steps taken and reforms pursued.


Northeastern States Continue Implementation of Comprehensive Reforms , Substantial Health Reforms: passed in 2008,  Maryland: Medicaid Expansion and Small Business Assistance ,  Rhode Island Pursues Health Reforms in Public and Private Sectors,  Attempts to Enact Comprehensive Health Reforms Face Obstacles ,  States Establish Frameworks for Health Reform,  State Coverage Strategies: Evolving with Time and Effort