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Market-based interventions have provided insufficient relief from rising commercial health care costs. As a result, states have a unique and pressing opportunity to enact policies that place downward pressure on unit prices and rebalance market power toward health care purchasers and consumers. The geographic, political, and economic diversity across the 50 United States opens possibilities for state governments to shape their own policy agendas; however, states will likely find that a single piece of legislation proves insufficient to deliver meaningful relief, and/or will create vulnerabilities that are easily exploited by stakeholders who benefit from the status quo. Therefore, state legislators may want to consider combinations or menus of policy options to create complementary infrastructure, close loopholes and plan for contingencies.