Rethinking Health Care Policy: The New Politics of State Regulation

States are increasingly important players in the current efforts to reform U.S. health care, as the federal government withdraws from this responsibility. Robert B. Hackey analyzes the varied routes states have taken in reformulating health care policy and provides a road map of what specific strategies work and why. In this comparative case study, Hackey focuses on four states--Massachusetts, New Hampshire, New York and Rhode Island--that have had markedly different experiences with regulating health care over the past two decades. Hackey's detailed comparisons show how the states' policies changed over time, moving from regulatory to market-oriented solutions, and examines which policy programs appear best poised to meet the future. Hackey uses regime theory to explain how the states' policy choices concerning cost control and entry regulation were shaped by the prevailing political culture and institution of each state. He concludes that the autonomy of state government form special interests is vital to the successful adoption, implementation and outcome of state initiatives. Rethinking Health Care Policy offers policymakers, planners and specialists useful insights into the politics of state regulation and into future directions for health care reform.