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While there are clear differences in both the policy and political environments at the state and federal levels, there is much that federal leaders can learn from states as they turn their attention to national health reform. This section only begins to touch on all the state-level health reform initiatives—both large and small—that can be instructive for federal policymakers. The upcoming sections on small group market reforms and quality and cost containment in particular include many additional “lessons learned” from state capitals across the nation.