Charting the Course

This year’s report not only analyzes the experience of states in the past year, but also explores the relationship between states and the federal government.

The states will be watching reform efforts at the national level, first for their possible immediate impact (for example, a short-term boost in the federal Medicaid matching rate to address the states’ budget shortfalls) and then to see how broader federal reform may impact their particular states. Particularly in light of severe budget deficits, some states may choose not to act in 2009 in the hope that federal coverage expansions and other reforms will be forthcoming.

Federal health policy-makers can learn from the experience of states that have pursued innovations in both coverage expansions and delivery and payment systems reforms. Since state efforts have dominated reform efforts recently, in part, because there has been little to no federal action, there is a wealth of experience and lessons that can inform the national discussion regarding health reform.

It remains to be seen whether the national discussion around health reform excites or dampens state efforts and what role states might play in a changing federal system.