A national health care reform law, the Patient Protection and Affordable Care Act, was signed into law in 2010. Implementation is ongoing, as are struggles to amend or outright repeal this law. The shape of health reform is changing at both the national and state levels. You are learning about several sweeping state reform initiatives that took place before the ACA was passed, and about varying degrees of changes occurring in states as a result or response to the law. In particular, several states have taken on comprehensive health care form programs to improve their health care delivery systems, increase insurance coverage, and/or control costs. This week, we will focus on state-level reform, keeping the national reform effort in mind as important context. Let's begin with the first question.

Based on the module notes and what you have learned so far this term:

• Do you believe that any state initiative could be effective at the national level? Why or why not?

Now applying your readings, go through the next two questions one at a time as a group, and then move on to the next. Choose one of the states that have enacted health care reform legislation from your readings (Massachusetts, Oregon, or Vermont).
• Describe the state's goals for health care reform. To what extent do you believe the state met its goals? As you describe the goals, consider how well this state balanced cost, access, and quality of health care. Please provide specific examples and be sure to discuss diversity in responses among classmates who have chosen the same state as you.


•How has this initiative evolved since the ACA was passed? Knowing what you know about state and national initiatives, would you recommend this initiative be implemented at the national level? In whole or in part? Are there ethical considerations you would want to address before replicating nationally? Please justify your recommendation using your readings and a minimum of 2 external credible resources.