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May 17, 1995

Making Health Reform Work: The View From the States

Author Affiliations

Clayton Fifer Associates Excelsior, Minn

JAMA. 1995;273(19):1544. doi:10.1001/jama.1995.03520430080047

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Contributors to this new book edited by DiIulio and Nathan include Lawrence D. Brown, James W. Fossett, Gerald Garvey, Donald F. Kettl, Michael S. Sparer, James R. Tallon, Jr, and Frank J. Thompson.

The book was published just at the time the president and Congress jettisoned their health reform proposals for 1994. It loses no relevance, however, because health care reform is still a major policy issue and will reemerge in the Republican-dominated Congress in 1995. Indeed, one of the major policy initiatives of the new Congress is reviving a discussion of federalism, the division of power between the central government and the individual states.

One major thrust of the book is that, while states have considerable administrative responsibility for Medicaid, environmental protection, and certificate-of-need legislation, they are unprepared to tackle the administrative burdens of health care reform at the state level.

The authors cite Minnesota and Washington as examples

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