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PubMed1987

Fiscal conditions and state government policy choices.

Decentralization of public program administration and financing to subnational units of government is examined in the context of hospital and nursing home assistance programs in the United States. Do subnational governments (i.e., states) adapt service utilization controls and tighter program eligibility during periods of fiscal austerity? Are these actions affected by expenditure levels, state budget balances, tax revenues, and the state's proportion of low income persons? Published data covering the period 1978-1982 from each of the 50 U.S. states were analyzed using multiple regression. States with a low proportion of low-income persons and a high per capita tax base were likely to increase minimum income eligibility standards to keep pace with inflation. All other states, regardless of fiscal condition, tended toward more restrictive income standards. States were equally likely to adopt utilization controls for health and long-term care services regardless of state revenue or health expenditures.

Health Policy↗
PubMed1996

Healthcare reform in the US. Momentum shifts from federal to state governments.

In the absence of federal leadership on comprehensive healthcare reform, a major restructuring of the delivery of healthcare in the US has occurred in the private sector and is well underway in many state legislatures. The influence of managed care continues to be pervasive. In 1994, 80%, or some 230 million, of the insured population in the US were included in a managed-care setting of some kind. This represents a 6-fold increase over the preceding decade. Healthcare reform has remained high on the list of legislative priorities for many states. Although initiatives vary, an increasing number of states are seeking federal waivers to broaden and restructure their Medicaid programmes so that groups of uninsured individuals can be included and all Medicaid recipients shifted into a managed-care setting. This paper provides an overview of the Medicaid waiver programme and other state initiatives. In addition, the paper reviews a decision of the US Supreme Court that recently established guidelines for states considering the imposition of surcharges or other revenue-generating mechanisms on private insurers as a means of funding uncompensated care.

Health Care Reform↗