New Roles for States in Health Reform Implementation Jun 01, 2010 By Raymond C. ScheppachAlan Weil 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 Health Affairs Raymond C. Scheppach Ray Scheppach is a professor of public policy at the Frank Batten School of Leadership and Public Policy and currently holds a joint appointment at UVA's Miller Center. Scheppach is a national expert on federalism and the role of states in our inter-governmental system and studies the role of governors as leaders on domestic policy issues. 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. Ray Scheppach on Virginia's State Budget Process News Batten professor Ray Scheppach shares his knowledge on the Virginia state budgeting process as a guest on the WTJU podcast Bold Dominion. Did US States Get More Money Than They Needed for COVID-19 Relief? News Interviewed for The Conversation, Batten’s Raymond Scheppach says the flood of federal money may have been a rare occurrence in federal-state relations: too much of a good thing.