Interest in overhauling the health insurance system has been reignited by the sharp increase in uninsured Americans in 2001, by evidence of continued erosion in private insurance coverage in 2002, and by mounting concern that states will cut back on public coverage in 2003. To spur action on this front, the Institute of Medicine recently issued a report calling for national support of state demonstrations to develop approaches for achieving universal coverage. This project will build on the momentum generated by this report by working directly with several states to craft state or regional initiatives and by developing the concept of federally supported demonstrations. To inform the policy debate, the project will also assess recent insurance trends that are pertinent to the design of reforms and estimate the number of uninsured who might gain coverage under different approaches. Results, which will be disseminated at national and state health policy forums, will contribute to consensus on ways to bring health coverage to greater numbers of Americans. http://www.gwu.edu