Devolution of power: an interim report card

During the mid-1990s liberals hoped that states would enact health insurance expansions, while conservatives looked to the states to contain costs. This essay considers whether states are meeting these great expectations. I review state performance in four policy priorities: encouraging Medicaid clients to enroll in managed care; expanding insurance coverage for children; making insurance more available and more affordable for the small-business community; and containing long-term care costs. The review suggests that states cannot accomplish these tasks without federal help. Congress seems to be getting the message and has enacted its own child health and insurance reform legislation. This trend is overdue and welcome.