TRANSLATING IDEAS INTO ACTIONS - ENTREPRENEURIAL LEADERSHIP IN STATE HEALTH-CARE REFORMS

States are often touted as 'laboratories'' for developing national sol utions to social problems. In this article we examine the appropriaten ess of this metaphor for comprehensive health care reform and attempt to draw lessons about policy innovation from recent state actions. We present evidence from six states that enacted major pieces of health c are legislation in the late 1980s or early 1990s: Massachusetts, Orego n, Florida, Minnesota, Vermont, and Washington State. The variation in design casts doubt on the proposition that states can invent plans an d programs for other states and the federal government to adopt for th emselves. Instead, we argue that it is more accurate to think of state s as specialized political markets in which individuals and groups dev elop and promote innovative products. We examine the factors that migh t create receptive markets for comprehensive health care reforms and c onclude that the critical factor these states shared in common was ski lled and committed leadership from ''policy entrepreneurs'' who formul ated the plans for system reform and prominent ''investors'' who contr ibuted substantial political capital to the development of the reforms . We illustrate different strategies that leaders in these states used to carry out the entrepreneurial tasks of identifying a market opport unity, designing an innovation, attracting political investment, marke ting the innovation, and monitoring its early production.