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In this report, we explore a wide range of policy options that attempt to introduce needed competition in provider markets and regulate prices directly. We argue that transparency initiatives will support both regulatory and competition-based policy options, and certain approaches to regulation complement and support efforts to improve market competition. Thus, although we largely divide the report in to two parts, competition and regulation, states do not have to select one course or the other but can take action in both areas.

In the report, we explore state efforts to do the following:

• promote transparency of price information, especially through all-payer claims databases 
• strengthen the effectiveness of antitrust enforcement by state attorneys general
• develop state public option plans to compete in provider markets
• develop state commissions to address health care costs and prices
• develop insurance and provider rate review and approval regulations
• impose price limits for state employee health benefit plans
• develop new approaches to state-based, hospital rate setting

We also examine the commonly held presumption that certificate of need programs are inherently anticompetitive because they present a major barrier to entry of would-be competitors.