Some states have opposed health reform by pressing for largely symbolic ballot measures to record opposition to the federal mandate to purchase health insurance, and in many cases, suing in court to block the mandate. Texas, despite the opposition to health reform from Gov. Rick Perry and Republicans in the state legislature, has been preparing itself to make the most of health reform. Now, Gov.

Everyone I talk with these days seems to feel that the greatest challenge facing health reform is the lack of capacity of states to take on both the new tasks and the new Medicaid enrollees that are vital to success. States face ongoing budget deficits, and are obligated to balance their budgets. Simply put, states cannot print money! And there are limits to their borrowing. So, unlike the federal government, states cannot push today’s problems onto the next generation.