Since the 1990s, state governments have been leaders of health care reform. Today, approximately 47 million people are without health insurance. As health care costs and uninsurance levels continue to rise, states are pursuing a variety of government- and market-based strategies to address this growing social problem. Health care research has indicated that state-based programs have proven to be successful in extending access to coverage. However, the question remains as to whether the market-based programs have had a positive impact on state health care. Advocates for market-based state health programs argue that the reforms benefit the greater good because they serve an economic development function by improving the economic productivity and overall health of state citizens. Whether market-based policies are accomplishing these goals is a matter of debate. This study examines the effects of the various market-based state policies. The evidence generated by this research sheds light on the societal effectiveness of market-based health care strategies used by state governments. The results of our analysis indicate that programs enacted by states to promote increased access to medical care have developmental effects beyond the client population directly served.
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