There is little doubt that the new administration will be forced to deal with the looming health care crisis in this country. But the political obstacles remain daunting, the least of which is the opposition by health care related interest groups. Most reformers believe that these groups are too powerful and would derail any single payer system as "big government." This type of influence is obvious even at the most basic levels of health care reform.;In 1965, the American Nurse Association (ANA) published a Position Paper that called for making the baccalaureate degree the minimum educational standard for Registered Nurses (RNs) and the associate degree as the minimum level of education for Licensed Practical Nurses (LPNs) (ANA 1965). The organization then established a proposed timeline for implementing the policy on a nationwide basis and chose four Licensed Practical Nurses (LPNs) (ANA 1965). The organization then established a proposed timeline for implementing the policy on a nationwide basis and chose four focus states as early implementers: Oregon, Montana, North Dakota, and Maine. In effect, these states were to act as legislative testing grounds for the proposal. The ANA chose these states carefully, believing that this new policy would be easily adopted in each. However, of the four states, only North Dakota was successful at getting the policy passed and implemented, but even that success was diminished when the policy was rescinded in 2003.;One question looms: why did such a simple policy proposal get derailed? In looking at why the policy was ultimately defeated in all four states, I find that opposition by the same health care related interest groups was instrumental in the policy's demise. This paper focuses on how and why these groups worked to oppose and ultimately defeat the policy in all four states.