States and the health care crisis

Article Abstract:

Kenneth E. Thorpe's analysis of how politics affects state efforts to control health care costs is useful but can be taken further by examining the cost containment strategies of New York and California. These strategies particularly concern the state reimbursement of hospitals. Comparing New York with California shows that the federal government should not eliminate long-standing state policy-shaping structures. Plans for national health care reform that will affect the federal-state division of authority will not succeed unless state politics is given due regard.

Analysis, Federalism, Prospective payment systems (Medical care)

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Politics matters! Health care policy and the federal system

Article Abstract:

The failure of Pres Bill Clinton's Health Security Act to pass the US Congress shows that the political climate matters to medical policy. The states took up health care reform at the same time for several reasons, including the increasing bill for Medicaid. Ideally, policy-making would take place with a federal framework and federal financial support and the states would act within that framework. This federal policy should make state obstructionism difficult. This seems just an ideal given the current political climate, but should still be an aim.

United States

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Decisions without consequences: cost control and access in state Medicaid programs

Article Abstract:

Differences between the states' policies for controlling Medicaid costs have produced considerable variation in beneficiaries' ability to obtain services. Analysis of data using logistic and ordinary least squares regression showed that these policies have strongly affected Medicaid enrollees' access to services, however their use of available services has been only slightly affected. In addition, policies specifically intended to reduce expenses by curtailing utilization have had little influence on either access or use.

Research, Medicaid

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