title: Hope in federalism? What can the states do and what are they likely to do?
abstract: Although ERISA is a barrier to state health care reform, its hurdle is not as formidable as the financial and political constraints that state governments face. As the states themselves confess, they cannot solve this problem alone (National Governors Association 1993); but if they must, they will focus on the incremental, "low-cost" reform options--insurance reforms and Medicaid managed care. Connecticut Representative Courtney perhaps summarized state sentiment best: "Maybe we shouldn't be using the word 'reform'; it raises expectations" (Spencer-Molloy 1994b). Indeed, states will proceed more cautiously now than just a year ago because the federal failure accentuated the political gamble of health care reform and made the future prospect of transferring federal funds to state governments appear very bleak. Unfortunately, such cautious reforms will not move us toward the goal of universal (or statewide) coverage, a goal that seemed within our grasp only two years ago.
authors.affiliation: Yale University, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Grogan
mesh_terms: D018166:Health Care Reform / Q000639:trends*; D007348:Insurance, Health / Q000331:legislation & jurisprudence; D008484:Medicaid / Q000331:legislation & jurisprudence; D011057:Politics; D013221:State Health Plans / Q000191:economics / Q000331:legislation & jurisprudence*; D013660:Taxes; D014481:United States