Abstract
The federal system of the United States gives states substantial latitude and authority to regulate their economic affairs. With health care having grown from 13.8% of the national economy in 2000 to 17.9% in 2010, state governments have developed a major stake in ensuring that relentless growth in health care spending is controlled more effectively. In Massachusetts, for example, the costs of Medicaid for low-income residents and private health insurance for state employees account for approximately 40% of the state budget. Rising insurance premiums are also dampening wages in the private sector. A recently enacted Massachusetts law that seeks to control health care spending may therefore provide useful policy lessons for other states and the federal government.