Health care system reform was one of the foremost political issues throughout 1993. While the Clinton Administration developed and proposed a national reform plan, many states enacted laws that call for altering the way in which health care is delivered to their residents. The following article examines health care reform legislation that was enacted at the state level in 1993. It focuses on managed competition plans, plans that seek to expand access to health insurance or to control health care expenditures, and plans that are aimed at reforming Medicaid and other state programs. Because so many states considered or enacted some type of health care reform legislation in 1993, this article provides an overview of the more significant reforms that became law, but it is not intended to serve as a comprehensive review of all state-level health care reforms.