Sustained Effort

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Many states are learning that health reform takes sustained effort over several years. This has played out in several ways:

  • Massachusetts did not pass comprehensive health reform until its third attempt. Both incremental and failed attempts at health reform can be seen as laying the groundwork for future efforts. Either can be a good educational process for both government and stakeholder groups. They can also build momentum and support for future efforts.
  • States like New Jersey, Iowa, and Wisconsin are taking a phased approach, also referred to as sequential reform—or incremental reforms with a “vision.” Policymakers are developing multi-year plans, enacting building block reforms and planning to pass additional reforms in subsequent years.
  • Many states—like Oregon, Colorado, and New Mexico—have developed a stakeholder process for putting together a reform proposal over time. In Oregon this process was set in place by the legislature, and was led by multiple working groups. In New Mexico, Governor Richardson led a three-year process of gathering input and putting together a plan.
Sustained effort is also needed once legislation has passed. States have learned that reform proposals can succeed or fail in the implementation process. Programs must have simple, understandable rules. Outreach and education are crucial. Government officials must continue to work with stakeholder groups to ensure the programs meet their needs and do not have negative unintended consequences. Plus, strong evaluation mechanisms must be put into place at the outset. Evaluations allow policy makers to adapt the program as needed as it moves forward.