New Roles for States in Health Reform Implementation Jun 01, 2010 By Raymond C. ScheppachAlan Weil New Roles for States in Health Reform Implementation New Roles for States in Health Reform Implementation State policies and implementation practices will largely determine whether the new federal health reform law translates into more affordable coverage and access to health care services. States will play particularly important roles with respect to Medicaid expansion, the creation of insurance exchanges, and the new market rules for insurance. The decision of whether or not to create an exchange looms as the most important and consequential one for states. To achieve effective implementation, each state will need a coherent vision to guide its work. States will need help from the federal government and stakeholders and must learn from each other during implementation. Health Affairs Raymond C. Scheppach Ray Scheppach is the former Executive Director of the National Governors Association (NGA) serving from January 1983-January 2011. Here, he became a specialist in the role of states in the formulation and implementation of public policy as well as in a broad range of domestic policy issues including welfare, education, health care and economic development. He was listed as a top association lobbyist by the Hill Magazine in 2006, 2007, 2008 and 2010, and Fortune Magazine listed NGA as the 12th most powerful lobbying organization in 1999. Read full bio Alan Weil Related Content Raymond C. Scheppach The Intergovernmental Grant System Research State and local government fiscal systems have increasingly become vulnerable to economic changes. Over the past three decades, state and local deficits during economic recession have been larger and deeper each time. Scheppach on the Opportunity States Have to Attack Income Inequality News As they rebuild their education, health-care and tax systems after the devastation of COVID-19, they can take important steps that can significantly narrow income and wealth disparities. Scheppach: COVID-19 Will Turn the State Pension Problem Into a Fiscal Crisis News You may be wondering why, over the last few months, the state pension problem – normally not a subject of widespread discussion – has been in the news. The problem – and it’s a big one – is that many of the public employee pension plans run by states don’t have enough money in them to make upcoming pension payments to retired state workers.