Medicaid: Political Durability, Democratic Process and Health Care Reform

Award Year:
Frank Thompson
Health Reform, Medicaid
In the face of mounting pressures to contain health care costs and strongly held partisan views about entitlement programs, what does the future hold for Medicaid? Will Medicaid, which costs more than $300 billion annually and provides coverage to some 55 million low-income Americans, be subjected to deep budget cuts? Or can it resist erosion and perhaps even expand to cover more of the nation's 47 million uninsured? Frank J. Thompson, Ph.D. explores these questions in his project, Medicaid: Political Durability, Democratic Process, and Health Care Reform. He examines Medicaid's structure as a federal grant program; its varied constituents, including the disabled and middle-class elderly as well as low-income mothers and children; characteristics of the American political system, such as federalism and party division, that often make program cuts more difficult; and the use of administrative rather than legislative strategies by the Clinton and Bush administrations to try to transform Medicaid. Thompson considers the possibilities for using Medicaid to expand insurance coverage, to shift more long-term care from institutions to communities, and to achieve other reforms that could promote innovation, transparency, and broader participation in policymaking.