151. Medicaid At 50: Remarkable Growth Fueled By Unexpected Politics.
- Author
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Sparer, Michael S.
- Subjects
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COST control , *COST effectiveness , *FEDERAL government , *HEALTH care rationing , *HEALTH care reform , *HEALTH services accessibility , *INSURANCE , *MANAGED care programs , *MEDICAID , *MEDICAL care , *HEALTH policy , *MEDICALLY uninsured persons , *PRACTICAL politics , *POVERTY , *STATE governments , *HEALTH insurance reimbursement , *GOVERNMENT programs , *STATE health plans ,MEDICAID statistics ,PATIENT Protection & Affordable Care Act - Abstract
Medicaid has grown exponentially since the mid-1980s, during both conservative Republican and liberal Democratic administrations. How has this happened? The answer is rooted in three political variables: interest groups, political culture, and American federalism. First, interest-group support (from hospitals, nursing homes, and insurers) is more influential than the fragmented group opposition (from underpaid office-based physicians). Second, Medicaid provides a partial counterweight to conservative charges of a federal health care takeover because of the states' roles in administering the program. Third, Medicaid's intergovernmental fiscal partnership creates financial incentives for state and federal officials to expand enrollment--expansions that these policy makers often favor, given the program's increasingly important role in the nation's health care system. This institutional dynamic is here called catalytic federalism. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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