title: Medicaid At 50: Remarkable Growth Fueled By Unexpected Politics.
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.
authors.affiliation: Michael S. Sparer (mss16@columbia.edu) is a professor and chair of the Department of Health Policy and Management at the Mailman School of Public Health, Columbia University, in New York City.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sparer
mesh_terms: D018166:Health Care Reform / Q000266:history; D006291:Health Policy / Q000266:history; D049673:History, 20th Century; D049674:History, 21st Century; D008484:Medicaid / Q000266:history* / Q000458:organization & administration; D058991:Patient Protection and Affordable Care Act / Q000266:history / Q000331:legislation & jurisprudence; D011057:Politics; D011203:Poverty / Q000266:history; D013219:State Government; D014481:United States
keywords: Access To Care; Financing Health Care; Health Reform; Insurance Coverage < Insurance; Medicaid