Pioneer Institute supports state-level experimentation in health care policy to test and drive the national debate on health care reform. Robust experimentation with welfare reform in the 90’s allowed federal officials to draw important lessons from the successes and failures of a number of states as they crafted a thoughtful national bill.

Massachusetts’ reform law: Pioneer produced a four-part Interim Report Card series to understand and measure the performance of Massachusetts’ 2006 health care reform law. In March 2011, Pioneer released Fixing the Massachusetts Health Exchange, an assessment of the Connector and recommendations for reform. In March 2012, Pioneer published a critically acclaimed, six-author book on state-based health care reform, The Great Experiment: the States, the Feds, and Your Healthcare.

State exchanges: With only two state exchanges currently in existence—in Massachusetts and Utah—we have a lot to learn. Every state is required to establish an exchange to serve individuals who receive tax credits or purchase insurance on their own, and a Small Business Health Option Program (SHOP) for employers with fewer than 100 employees by 2014. Without action, states will be mandated to accept a federally-designed one-size fits all exchange. With modest support for the federal health care overhaul law among the public and opposition in some state executive offices, the Obama Administration will need to give states significant flexibility in implementing the law. The Administration should allow for a wide diversity of designs that help to address each state’s unique demographic and health care challenges.