The Time for State-Based Healthcare Reform

In this commentary, we discuss our thoughts on the future of healthcare reform in the United States. While public discourse on healthcare reform still focuses on the federal government and the Affordable Care Act, including the possibility of repeal, we argue that states are poised to continue the momentum started by the federal government. Implementation of Medicaid expansion, Delivery System Reform Incentive Payment waivers, State Innovation Waivers, and all-payer claims databases are examples of state-level opportunities to further the progress driven by the federal government on issues of cost, access, and quality. This shift in focus to state-based initiatives, bolstered by the recent elections and political appointments, raises important challenges, ranging from budget shortfalls to state-level political gridlock. Policymakers, researchers, and other stakeholders ought to recognize this trend and its implications for their work. We offer a few recommendations to help states successfully seize the opportunities available to them to drive reform and innovation. These include engaging in publicprivate partnerships, joining neighboring states in unified efforts, and creating infrastructure to borrow promising programs from other states.