Universalism within Targeting: Nursing Home Care, the Middle Class, and the Politics of the Medicaid Program

In contrast to “targeting within universalism,” in which extra benefits are directed to low‐income groups within the context of a universal policy design, the reliance of mainstream elderly on means‐tested Medicaid benefits represents the inverse pattern of “universalism within targeting.” During moments of intense debate, policy elites have strategically reframed Medicaid as a broad‐based social entitlement, yet many politicians remain ambivalent about using a program originally intended for the poor to protect the middle class. The analysis suggests that universalism and targeting are best seen not as fixed, technical features of program structures but rather, as the political raw materials with which politicians contest the multiple and conflicting purposes of the American welfare state.