Improving access to care for the underserved: state-supported volunteerism as a successful component.

Abstract

1993 signaled a policy retreat at the federal level. Rather than the sweeping reform that was expected, growth in government-sponsored health insurance coverage would be, at best, incremental. Enactment of the Title XXI Children’s Health Insurance Program, as part of the Balanced Budget Act of 1997, was such an incremental measure. With a vacuum in health care policy leadership at the federal level, the baton was handed to the states. Responsibility and authority for health and welfare under the US Constitution is allocated between the federal government and the states. Given the fact that the balance favors the states, it is reasonable for state and local governments to become laboratories for meaningful health care change. This article describes Florida’s successful experimentation with sovereign im