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In recent years, New Jersey has substantially expanded its role in health financing. Public coverage has increased, especially for low- and moderate-income children, and so has public oversight of private coverage. This is a marked shift from the prior era of active public retrenchment and downsizing. During the early to mid-1990s, the state had been implementing hospital deregulation, major reductions in support for hospital uncompensated care, cuts in hospital and nursing home rates, and mandatory Medicaid managed care for cash-assistance beneficiaries. Such downsizing had been prompted both by economic downturn and a shift in political philosophy as Republicans assumed control of the governorship and both houses of the legislature in the early 1990s.