THE STATES AND HEALTH-CARE REFORM - THE ROAD TRAVELED AND LESSONS LEARNED FROM 7 THAT TOOK THE LEAD

During the past decade, an area of major policy activity among the sta tes has been that of health care reform. As of May 1993, seven states- Florida, Hawaii, Massachusetts, Minnesota, Oregon, Vermont, and Washin gton-had progressed the furthest in enacting comprehensive statutes de signed to expand health insurance coverage and slow the growth of heal th care costs. This article reviews the activities of these states to achieve health care reform and the lessons learned from those activiti es. The analysis focuses specifically on identifying the common proble ms addressed and determining the common factors that maximized states' opportunities for success. In all, some nine lessons are identified t hat have relevance for other states wishing to follow a similar road t o reform. Most important among these are a ''window of opportunity'' f or policy action, having entrepreneurial leadership to push the reform agenda forward, and support from key stakeholder interests. If these conditions of opportunity, policy entrepreneurship, and stakeholder co mmitment are met, a state can move forward in addressing key aspects o f its health care reform agenda.