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January 18, 1995

States Face Rocky Road to Reform

JAMA. 1995;273(3):187-188. doi:10.1001/jama.1995.03520270021020

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WHEN NATIONAL health system reform withered and died last September, state governments took center stage. Their reputations as "laboratories" for innovation and creativity grew, as the nation soon realized that reforms would be incremental rather than comprehensive.

There's no doubt that the states will proceed with reform efforts in 1995. But many of the results—or lack thereof— will carry the imprint of two main elements in the states' formula for reform: waivers from the federal Health Care Financing Administration (HCFA) that allow state experimentation with Medicaid programs and the Employee Retirement Income Security Act of 1974 (ERISA) that governs employee benefit plans.

"Even though national reform didn't materialize, the important issues have not gone away. Now the states will be the pressure point, and we can be effective, particularly if we get cooperation from the federal government," says Pennsylvania State Sen Allyson Schwartz (D, Philadelphia).

Medicaid Waivers  One such avenue

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