Since the 1970s, health care costs have been rising faster than general inflation and the proportion of the population without health insurance has been rising. Currently, the number of people in the country without health insurance is about 45.7 million.

States have been at the forefront of efforts to expand the numbers of the insured. In recent years, some states have also focused considerable attention on efforts to improve health care quality and control the rate of increase in health care spending. Among the many roles that states take on as overseers and administrators of the health care system in the United States, three are central to state efforts at reform.

This is one in a series of policy briefs written for the 2009 Policy Leaders Academy Health Care Forum.