States have used the Bush administration's Health Insurance Flexibility and Accountability (HIFA) initiative primarily to expand coverage, not to cut costs, says a Health Affairs Web Exclusive published April 18. The article, by the Urban Institute's Teresa Coughlin and coauthors, says that states contributed new funds to expand coverage, despite their generally dismal budget pictures in the early 2000s, but that fiscal pressures still impede progress in some cases, notably California.

In a Health Affairs Web Exclusive interview, also published April 18, Gordon Bonnyman tells Robert Hurley that politics, not policy, killed TennCare, Tennessee's controversial Medicaid waiver expansion program. Bonnyman, who heads the Tennessee Justice Center, says that the TennCare expanded coverage and improved outcomes. He charges that recent efforts by Tennessee Gov. Philip Bredesen (D) to "fix" the program have led to "the largest single increase in the number of uninsured Americans in the nation's history."

Recent decades have seen fewer new drug introductions, but the therapeutic and commercial importance of the drugs that have been launched has gone up, say Henry Grabowski and Richard Wang in the March/April Health Affairs. They report that U.S. pharmaceutical and biotech companies have forged ahead, as has the U.S. as a first-launch market. However, they also note looming threats to U.S. progress, such as the ban on federal funding for new embryonic stem cell lines and the recent wave of early patent challenges to innovative drugs.