Health Policy Reform in America
Innovations from the States
Second Edition
Health Policy Reform in America
Innovations from the States
Howard M. Leichter
Editor
First published 1997 by M.E. Sharpe
Published 2015 by Routledge
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Library of Congress Cataloging-in-Publication Data
Health care policy reform in America: innovations from the states/
edited by Howard M. Leichter.2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 1-56324-899-9 (c: alk. paper).
ISBN 1-56324-900-6 (p: alk. paper)
1. Medical policyUnited States. 2. Health care reformUnited States.
3. Medical policyUnited StatesStates.
4. Health care reformUnited StatesStates.
I. Leichter, Howard M.
RA395.A3H42564 1997
362.1'0973dc20
96-43276
CIP
ISBN 13: 9781563249006 (pbk)
ISBN 13: 9781563248993 (hbk)
To Elisabeth, Laurel, and Alexandra, the three most important people in my world
Howard M. Leichter, Ph.D., is chairperson and professor of political science, Linfield College, McMinnville, Oregon. He is also a clinical professor of public health and preventive medicine, Oregon Health Sciences University, and a member of the board of editors of the Journal of Health Politics, Policy and Law.
Raymond G. Davis, Ph.D., is associate professor and chair, Department of Health Services Administration, University of Kansas. He has served on a number of health-related boards and groups for the state of Kansas.
Robert M. Fielder, J.D., is a doctoral student and research assistant in the Policy Sciences Graduate Program at the University of Maryland Baltimore County. From 1990 to 1994 he practiced law for a Michigan firm representing hospitals and other health care organizations on legal and regulatory issues.
Darnel M. Fox, Ph.D., is president of the Milbank Memorial Fund. His most recent book is Power and Illness: The Failure and Future of American Health Policy (Berkeley: University of California Press, 1995).
Barbara E. Langner, R.N., Ph.D., is associate professor and associate dean, School of Nursing, University of Kansas. She is a health policy consultant to the Kansas Department of Social and Rehabilitation Services, and a member of the Kansas Insurance Department Health Care Advisory Board. She served as the executive director of the Kansas Commission on the Future of Health Care, Inc.
Deane Neubauer, Ph.D., is professor of political science at the University of Hawaii, Manoa. For the past ten years his work has concentrated on health care policy and health care reform, areas in which he has published extensively. In 1992 he was facilitator of Hawaii's Governor's Blue Ribbon Committee on Health Care Costs.
Thomas R. Oliver, Ph.D., is assistant professor in the Policy Sciences Graduate Program at the University of Maryland Baltimore County. He was a postdoctoral fellow in the Pew Health Policy Program at the University of California, San Francisco, and currently holds an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation for a study entitled "Public Entrepreneurship and Health Policy Innovation."
Michael S. Sparer, Ph.D., is an assistant professor in the Division of Health Policy and Management in the School of Public Health at Columbia University. He spent seven years as litigator for the New York City Law Department, specializing in intergovernmental social welfare litigation. He is the author of Medicaid and the Limits of State Health Reform (Philadelphia: Temple University Press, 1996).
Jean I. Thorne, M.A., is currently the federal policy coordinator for Oregon Governor John Kitzhaber. For the past eight years she served as the state's Medicaid director. In that capacity, she oversaw the planning and implementation of that state's Medicaid reform under the Oregon Health Plan.
In the Preface to the first edition of this book, published just before the 1992 presidential election, I wrote that the 1990s might prove to be one of those rare decades in political astronomy in which the constellations of public and elite opinion will be in perfect alignment. It seemed, at that time, that both the public and the nation's political leaders were in agreement that the nation's health care system was in a state of crisis and that some fundamental change was needed to rein in costs and expand access to 37.4 million Americans (in 1992) who had no health insurance. The election of Bill Clinton, who had made health care reform a central feature of his presidential campaign, appeared to secure a prominent role for health reform in the nation's political firmament.
In the intervening five years Americans have witnessed the defeat of the Clinton Health Security Bill ("health care that can never be taken away"), the continuing and crippling climb, albeit somewhat more slowly, of health care costs (between 1990 and 1996 national health expenditures increased from $697.5 billion or 12.1 percent of the gross domestic product to $1 trillion or 14 percent of GDP), and an increase from 36 million uninsured people in 1992 to 42 million in 1996. It is politically noteworthy that one-third of the uninsured live in families with incomes that are more than $30,000, double the federal poverty level for a family of four.
In a sense, then, little has changed in terms of the problems that catapulted health care to the top of the nation's public policy agenda in the early 1990s. What has changed is that the focusand hopeof reforming the American health care system has shifted back to where it was prior to the abortive national effort, namely the states (and the private sector). Reviewing the Clinton record on the eve of the 1996 presidential campaign, two New York Times reporters assessed the impact of Clinton's health reform failure and concluded: "Some three years later, 40 million Americans are without health insurance. And the Administration's principal legacy in
Not only has the locus of health care reform policy switched but the political realities of reform have also changed. Simply stated, the task of fixing the health care system is a good deal more formidable than it was in the late 1980s and early 1990s when the states first put health care reform on the policy agenda. As a number of the selections in this book demonstrate, the failure of the Clinton plan, and all the political fallout attending that event, poisoned the well of reform by exacerbating the already high level of disillusionment many Americans feel about the capacity of government to solve the country's problems. This, in turn, has made state policy makers more timid about embarking on changing the health care system and opponents of reform more bold in their resistance to change.
