The author contends that Oregon is a leader in the effort to guarantee low-income residents access to affordable health insurance. State policies contributed to a rapid decline in the number of uninsured residents. Oregon's long-term care system is also a national model. It ranks first in the nation in its commitment to home- and community-based services. Despite these achievements, the report finds three future challenges facing the state: it must address the recent rise in uninsured residents; the withdrawal of several commercial HMOs from the Medicaid market may be cause for concern; and the maturation of Oregon's innovative long-term care system may create new challenges.