How much responsibility for providing health care to the poor should be devolved from the federal government to the states? Any answer to this critical policy question requires a careful assessment of the Medicaid program. Drawing on the insights of leading scholars and top state health care officials, this volume analyzes the policy and management implications of various options for Medicaid devolution. Proponents of devolution typically express confidence that states can meet the challenges it will pose for them. But, as this book shows, the degree to which states have the capacity and commitment to use enhanced discretion to sustain or improve health care for the poor remains an open question. Their failure to attend to issues of politics, implementation, and management could lead to disappointment. Chapters focus on such topics as Medicaid financing, benefits and beneficiaries, long-term care, managed care, safety net providers, and the appropriate division of labor between the federal government and the states. The contributors are Donald Boyd, Center for the Study of the States; Lawrence D. Brown, Columbia University; James R. Fossett, Rockefeller College; Richard P. Nathan, Nelson A. Rockefeller Institute of Government, State University of New York, Albany; Michael Sparer, Columbia University; James Tallon, United Hospital Fund; and Joshua M. Weiner, the Urban Institute.

Medicaid, one of the largest federal programs in the United States, gives grants to states to provide health insurance for over 60 million low-income Americans. As private health insurance benefits have relentlessly eroded, the program has played an increasingly important role. Yet Medicaid's prominence in the health care arena has come as a surprise. Many astute observers of the Medicaid debate have long claimed that "a program for the poor is a poor program" prone to erosion because it serves a stigmatized, politically weak clientele. Means-tested programs for the poor are often politically unpopular, and there is pressure from fiscally conservative lawmakers to scale back the 350-billion-per-year program even as more and more Americans have come to rely on it. For their part, health reformers had long assumed that Medicaid would fade away as the country moved toward universal health insurance. Instead, Medicaid has proved remarkably durable, expanding and becoming a major pillar of America's health insurance system. In "Medicaid Politics", political scientist Frank J. Thompson examines the program's profound evolution during the presidential administrations of Bill Clinton, George W. Bush, and Barack Obama and its pivotal role in the epic health reform law of 2010. This clear and accessible book details the specific forces embedded in American federalism that contributed so much to Medicaid's growth and durability during this period. It also looks to the future outlining the political dynamics that could yield major program retrenchment.

How Trump has used the federal government to promote conservative policies The presidency of Donald Trump has been unique in many respects most obviously his flamboyant personal style and disregard for conventional niceties and factual information. But one area hasn't received as much attention as it deserves: Trump's use of the "administrative presidency," including executive orders and regulatory changes, to reverse the policies of his predecessor and advance positions that lack widespread support in Congress. This book analyzes the dynamics and unique qualities of Trump's administrative presidency in the important policy areas of health care, education, and climate change. In each of these spheres, the arrival of the Trump administration represented a hostile takeover in which White House policy goals departed sharply from the more "liberal" ideologies and objectives of key agencies, which had been embraced by the Obama administration. Three expert authors show how Trump has continued, and even expanded, the rise of executive branch power since the Reagan years. The authors intertwine this focus with an in-depth examination of how the Trump administration's hostile takeover has drastically changed key federal policies and reshaped who gets what from government in the areas of health care, education, and climate change. Readers interested in the institutions of American democracy and the nation's progress (or lack thereof) in dealing with pressing policy problems will find deep insights in this book. Of particular interest is the book's examination of how the Trump administration's actions have long-term implications for American democracy.

This title is part of UC Press's Voices Revived program, which commemorates University of California Press’s mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1975.

This title is part of UC Press's Voices Revived program, which commemorates University of California Press’s mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1975.