In the 1970s and 1980s, a number of states adopted all-payer rate-setting systems as strategies to control the rate of increase in health care costs. These systems brought stakeholders to the table to negotiate the allocation of costs associated with caring for the uninsured and created, briefly, an opportunity for states to address access problems more broadly with the participation of major stakeholders. This article uses a case study of Maine and comparisons with other states to argue that the payment disparities between public and private payers that have grown over time since the demise of all-payer systems constitute a significant barrier to successful health reform.

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