Abstract
Most communities support their safety-net facilities, but few supply health coverage for uninsured residents. In 1991 Hillsborough County, Florida, created a health care plan that raised the sales tax by a half-cent, used the proceeds to cover about 30,000 uninsured county residents, and assured the public that this would save money. In time, however, various conflicts combined to call into question the plan's ends and means. These challenges reinvigorated advocacy by the plan's supporters, who steered the adoption of changes that seemed to have "institutionalized" it. Community-based reformers might find this local innovation instructive as they ponder how to build enduring programs.
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