Federalism and Health Care

Abstract

Among the many issues in the national health care debate is the role of the states. Some have asked whether the states can tackle health care on their own and have answered with a resounding “no.” Deborah Stone (1992), for example, argues that health care is too big a challenge for the states to handle: they lack sufficient autonomy from the federal government in certain areas and sufficient power over private interests in others.But apparently, states are undeterred by such thinking. In the early 1990s, three states—Minnesota, Washington, and Florida—passed comprehensive bills incorporating elements of managed competition. Massachusetts, Oregon, and Vermont had already enacted (but not implemented) major reforms based upon different philosophies. And Hawaii led the way in 1974 with its enactment of an employer mandate.Today, reform activity is everywhere. In 1993, 1,850 health care reform proposals were introduced in state legislatures; this year virtually every governor is working on some health care initiative. Even Lowell Weicker, Jr., governor of Connecticut, home to the nation's largest insurance companies, has announced his intention to provide universal coverage by 1997. The states are definitely not waiting around to see what the feds will do.