In April 1994, during the conference on “Health Care Reform and the Role of the States,” in Chicago which ultimately lead to this volume, a debate raged among scholars of health care policy over the relative merits of state versus national leadership in health care reform. 1 A common rendition of the question being asked at the time was “Can states take the lead in health care reform?” (Moon and Holahan 1992). 2 A common response, in the literature and at the conference, was that health care reform was “simply too big a problem to be handled at the state level” (Stone 1992: 51). 3 The solution was for the federal government to comprehensively reform the nation’s health care system. 4