At various times advocates, politicians, policy analysts, and concerned citizens have recommended reforms of state small-group and non-group (individual) health insurance markets. The early- to mid-1990s was a period in which health care issues rose to the top of federal and state agendas, and we appear to be entering another such period of acute interest in expanding health insurance coverage. While few have forgotten the failed Task Force on National Health Care Reform under the Clinton Administration, more easily forgotten are the concurrent efforts by states to provide universal health insurance coverage. There are important lessons to be learned from generations of state initiatives, lest states be condemned to relive the failed policies of the past.