Laura Katz Olson - Politics of Medicaid

THE POLITICS OF MEDICAID

FOR MY SISTER ANNIE

CONTENTS

This book is an attempt to make sense of Medicaid, a program that encompasses a labyrinth of fifty separate state government plans that are regularly in flux (as some students of the subject famously observe, If youve seen one Medicaid program, youve seen one Medicaid program); countless national rules and regulations, many of which are repeatedly waived; myriad, volatile funding sources; a large range of health industries, professionals, and their trade associations, representing hundreds of thousands of private contractors with diverse agendas, stakes in the program, and levels of integrity; and a patchwork of categorical and financial participation standards that differentiate within and among the millions of low-income families, regardless of their medical needs. Add to the mix the numerous other entities that to varying extents affect and are affected by welfare medicine (including employers, workers, and their communities) and the ever-changing political winds steering its policies. No one designed the existing program; rather, it is a perplexing Rube Goldberg of incremental adjustments and periodic enhancements or cutbacks, at both the national level and the state level, which rarely work in concert.