Medicaid Politics And Policy

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Medicaid is a story worth telling, one rooted in American history and shaped by its culture and institutions. It has dramatic interest, heroes and heroines, triumphs and tragedies. The authors make this story come alive for the reader by providing a strong connected narrative, detailed accounts of important policy changes, and extensive use of interviews with individuals close to events. They emphasize politics and policy along with history. History is important because Medicaid has developed incrementally, layer by layer, so that almost any provision or activity needs a historical gloss to understand it. The Medicaid program has been especially subject to outside political and policy influences: the state of the economy, trends in federalism, developments in health or welfare programs, and the electoral cycle. Politics helps us understand policy outcomes. But the two go together: a knowledge of policy helps understand what is at stake, and a knowledge of politics what is possible.

A central theme of the book is that Medicaid is a "weak entitlement," one less established or effectively defended than Medicare or Social Security, but more secure than welfare or food stamps. Medicaid has the flexibility to adapt (or be adapted) as well as a capacity to defend incremental and opportunistic gains. At the same time, the program lacks an effective mechanism for overall reform. It has grown enormously since its inception to become the largest health insurance system in the country, a source of perennial complaint and, most recently, of continuing crisis.

The dual emphasis upon politics and policy is important to make the arcane Medicaid program accessible to the reader, and to distinguish policy grounded in facts and analysis from partisan bombast and ideology. The result is an authoritative account and reference for those seeking to refresh a perspective or to look further.

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Editorial Reviews

From the Publisher
“Perhaps only a political and policy enthusiast like me would really enjoy this book.” —Steven S. Sharfstein, Psychiatric Services "This book is going to be a classic (and standard reference) in the field." Dr. Lloyd S. Etheredge, Director, Government Learning Project "Experts discuss the interface of U.S. politics and health policies. This case study of Medicaid illustrates how good intentions to create health policy for vulnerable populations in the U.S. have been and continue to be influenced by state and federal economic issues; societal views of poverty, disability, old age, and charity care; and changing views of federalism, depending on the ruling political parties in office at stage and national levels....Interviews with key players and historical documents illustrate three phases of Medicaid implementation and growth: 1966-81; 1981-95; and 1995-2007. Extensive references, bibliographic sources, and glossary. Recommended." J.E. Thompson, Choice "[S]tudents of health politics and policy will find this book the go to source for understudying how Medicaid became the nation's go to program for filling the health system's myriad gaps. Today, Medicaid expansions are fundamental to plans in, for example, Massachusetts and Vermont that aspire to universal coverage and in the health agenda of the leading Democratic presidential candidates." Lawrence D. Brown and Michael S. Sparer, Health Affairs “Offering a panoramic sweep of the Medicaid program and its place in the U.S. health care policy and politics, Medicaid Politics and Policy: 1965-2007 represents an important addition to the health policy literature… Using an approach that organizes the story of Medicaid into distinct chapters that help explain this most complex of all social welfare programs, Medicaid Politics and Policy also illuminates the broader social, political, and economic currents that enveloped and that continue to swirl around the program… Medicaid is no less than the fundamental means by which a society that values markets in health care has made a place at the health care table for the poor, the sick, and the medically underserved.” —Sara Rosenbaum, Journal of Health Politics, Policy and Law
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Product Details

  • ISBN-13: 9781412810883
  • Publisher: Transaction Publishers
  • Publication date: 12/1/2009
  • Pages: 460
  • Product dimensions: 6.30 (w) x 9.30 (h) x 1.00 (d)

Meet the Author

David G. Smith is Richter Professor Emeritus of Political Science at Swarthmore College. He is the author of The Children’s Health Insurance Program and Paying for Medicare. His book, Paying for Medicare, won the Elizur Wright Award from the American Risk and Insurance Association.

Judith D. Moore was senior fellow, National Health Policy Forum, George Washington University. She was a past director of the Medicaid program and the Office of Legislation and Congressional Affairs.

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Table of Contents

Preface vii

Acknowledgments xiii

1 Historical Background 1

2 Legislating Medicaid 21

3 Medicaid Implementation 59

4 Amending the Classical Model 95

5 Maturity and Trouble 145

6 A Critical Phase 227

7 Medicaid Under Siege 279

8 Devolution and Waivers 323

9 Past and Future 369

10 Postscript 405

Glossary 413

Bibliography 423

Index 433

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