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States and Health Care Reform—Laboratory, Stepping Stone, or Stumbling Block?

“All politics is local” is a maxim coined by Thomas “Tip” O’Neill, former Speaker of the US House of Representatives, and most people probably think that’s a good thing and a key feature of our democracy. And, of course, most people know that “all health care is local.” So even though the fate of the Patient Protection and Affordable Care Act (ACA) is being debated on a national stage today, the future of health reform is likely to take on a local flavor, no matter who prevails on November 6.

Indeed, what states do or do not do—and how well they do it—will largely determine how well the ACA achieves its goals. In the case of health care, whether this reliance on state variation promotes or retards the rapid reformation of our health care system is an open question.

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