From Targeting to Universalism? The Limits and Possibilities of Institutional Change in the Medicaid Program

Award Year:
Colleen Grogan
Medicaid, Health Insurance
Significant social policy debate focuses on why the U.S. never achieved guaranteed health insurance for all citizens and whether universal or targeted programs are the answer. The typical American approach is to enact targeted programs and then focus on incremental expansions. Thus the crucial policy question is whether targeted programs can transform themselves into programs with universal characteristics. Dr. Grogan's project centers on the Medicaid program and its evolution from a public assistance program for the indigent to a payer of long-term care services for the middle class. Her objectives are threefold: 1) document Medicaid's partial universalization, analyzing how and why this expansion occurred; 2) evaluate its impact on the treatment of originally-targeted groups and on policymakers' support for the program; and 3) examine whether Medicaid's policy legacy limits the prospects for further expansions to new population groups or for improved services to existing Medicaid groups.