States & Coverage

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How to best provide health insurance coverage in the United States has always been a complicated and controversial public policy issue, often fueled by deep philosophical and political differences. Regardless of political ideology, policymakers, researchers, and advocates agree that the escalating cost of health care is a major contributor to the high levels of uninsurance in the United States. Among the many stakeholders that play a major role in the issue of health insurance coverage, states are one of the most critical. Not only do states regulate their own insurance markets, they also are providers and purchasers (e.g., through Medicaid and also by providing health insurance coverage to state employees as a large employer). States have always been a part of the coverage debate as they struggle to maintain their public programs and effectively serve as the laboratory for new coverage models. Now, with the landmark passage of the Patient Protection and Affordable Care Act, the U.S. will embark on a historic course for covering a majority of the uninsured and the states’ role will only be more amplified.