An annual survey by the National Institute for Early Education Research has traced state pre-K policy change in the United States since 2001. Such programs are only one part of a system that also includes a large federal program (Head Start) and a large private sector. The last decade was one of large changes in enrollment, policies relating to access and quality, and expenditures. Not all of these chances were positive, and it appears that the Great Recession had substantial negative impacts. Major trends in state pre-K include large enrollment growth at age 4, while enrollment at age 3 changed little, universal adoption of comprehensive early learning standards and, modestly, in program quality standards. On the downside, state expenditure per child fell by more than $1,000 adjusting for inflation over 10 years. Some disadvantaged groups who might benefit most from high quality state pre-K have the least access, such as English language learners and Hispanic children. State policies show extreme variation, and the range increased over the decade. Some states moved to universal enrollment while others still have no program. State funding per child varies by almost $10,000 per pupil from highest to lowest. Surveys such as this are an important tool for understanding how policy varies over time and geopolitical boundaries as well as examining equity in access to quality.