This chapter provides a discussion of the conclusions and implications of this research. In many respects, the assumption of initial state interest and resources sufficiency has not been met, although many states have been able to overcome their initial deficiencies in the intervening years. While most observers conclude that the Water Quality Act has served to improve water quality in the nation, the lack of a valid, reliable, and agreed-upon measure of state water quality hampers the ability to reach specific conclusions about the overall effects of the Water Quality Act. The conclusions also highlight the tensions between the financial and environmental elements of the Clean Water State Revolving Fund program, as well as tensions between national environmental goals and state choice in program implementation.