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State case studies point to perils and possibilities for federal health reform

June 26, 2009

  • UCLA Center for Health Policy Research
    ​Two new reports draw on case studies of state health reform to highlight important lessons in politics and policy for federal and state health reform. In "Swimming Upstream: The Hard Politics or Health Reform in California" and "Politics and Policy in State Health Reform," Walter Zelman, Ph.D., offers a cautionary tale for reform and identifies key lessons for policymakers and reform advocates.

    Zelman, Chair of the Department of Health Science at California State University, Los Angeles, and a veteran of the Clinton reform effort, writes that while some states can and have successfully implemented health insurance expansions and cost control reforms, most have been unable to clear the hurdles of financing or successfully accommodate the demands of various special interests. The reports also address the critical role of political leadership and the impacts of systemic forces such as economic trends and political institutions. 

    "Initially, everyone said 2009 would be the year for national health reform, but that's what they said about California in 2007," says Zelman. "The successes and failures of states like California, Pennsylvania, Illinois, and Massachusetts illustrate the challenges facing President Obama and the Congress, and offer important lessons about the need to control rising health care costs, find stable funding sources, and establish a balance between state and federal responsibility." 

    State reform, Zelman argues, is federal reform, and vice versa. He concludes that the sizable challenges of state reform financing, especially in difficult economic times, mean that success in coverage expansions efforts will depend largely on decisions at the federal government level. State reform will continue to depend on federal financing; and federal reform, if enacted, will leave much to the states. 

    Download the papers:


    These papers are being released by the State Coverage Initiatives, a national program of the Robert Wood Johnson Foundation that provides timely, experience-based information and assistance to state leaders in order to help them move health care reform forward at the state level, and the UCLA Center for Health Policy Research, one of the nation's leading health policy research centers and the premier source of health-related information on Californians.