This report was prepared for the U. S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation under Contract # HHS-100-99-0007. Other contributors to the report include S. Courtney Bickert and Alice Lapray. We gratefully acknowledge the thoughtful guidance of ASPE staff Kelleen Kaye, Sonia Chessen, and Meredith Kelsey as well as former ASPE Division Director Matthew Stagner. We also thank Michele Zimowski for helpful comments on an earlier draft. All opinions are those of the authors and do not necessarily reflect the positions of the Department of Health and Human Services or its staff.