Medicaid Politics

Federalism, Policy Durability, and Health Reform

Frank J. Thompson

"Any collection strong in Medicaid and health care reform processes will find this invaluable."
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Medicaid, one of the largest federal programs in the United States, gives grants to states to provide health insurance for over 60 million low-income Americans. As private health insurance benefits have relentlessly eroded, the program has played an increasingly important role. Yet Medicaid’s prominence in the health care arena has come as a surprise.

Many astute observers of the Medicaid debate have long claimed that “a program for the poor is a poor program” prone to erosion because it serves a stigmatized, politically weak clientele. Means-tested programs for the poor are often politically unpopular, and there is pressure from fiscally conservative lawmakers to scale back the $350-billion-per-year program even as more and more Americans have come to rely on it. For their part, health reformers had long assumed that Medicaid would fade away as the country moved toward universal health insurance. Instead, Medicaid has proved remarkably durable, expanding and becoming a major pillar of America’s health insurance system.

In Medicaid Politics, political scientist Frank J. Thompson examines the program’s profound evolution during the presidential administrations of Bill Clinton, George W. Bush, and Barack Obama and its pivotal role in the epic health reform law of 2010. This clear and accessible book details the specific forces embedded in American federalism that contributed so much to Medicaid’s growth and durability during this period. It also looks to the future outlining the political dynamics that could yield major program retrenchment.

Table of Contents

1. Medicaid and the Health Care Crucible

2. Dodging the Block Grant Bullet and Other Signs of Resilience

3. Beyond Welfare Medicine: The Take-Up Challenge

4. Government by Waiver: The Quest to Transform Long-Term Care

5. Demonstration Waivers and the Politics Of Reinvention

6. Reform: The Politics of Polarization

7. Durability, Federalism, and the Future of Medicaid


1. Medicaid Expenditures

2. Medicaid Enrollees

3. Medicaid Provisions of Key Debt Reduction Plans




"The book provides an excellent analysis of the Medicaid program, while strengthening understanding of the broader questions regarding how the policy process works."—Choice

"For anyone wishing to gain deeper insight into Medicaid policy or how policy is made in instances of cooperative federalism, Medicaid Politics is a worthwhile read… it offers a thorough explanation of policy history and sheds light on the processes behind creating Medicaid policy since 1993 [and] presents a good sense of the trade-offs in policy decisions and the details of implementation."—Publius

"Any collection strong in Medicaid and health care reform processes will find this invaluable."—Midwest Book Review

"Frank Thompson has written an important and much needed book. This volume represents a major contribution to the literature on state health policy-making, and Medicaid policy in particular, but it is also ideally suited for use in both graduate and advanced undergraduate courses in health policy, federalism, and public policy. Thompson's scholarship is first rate, and his discussion of democratic governance, accountability, and program durability brings a fresh new perspective to the study of state Medicaid reform. In doing so, he provides readers with a way to understand not only the evolution of Medicaid policy, but the political significance of federalism for health care reform."—Robert B. Hackey, professor and director, Health Policy and Management Program, Providence College

"One of the most remarkable developments in the American welfare state over the past half century has been the stunning growth of Medicaid. Once dismissed as Medicare's poor cousin, Medicaid today stands as a key pillar of the US health insurance regime. The expansion of Medicaid was at the center of President Obama's health care reform, and the program is increasingly viewed as a bridge to universal coverage. In Medicaid Politics, political scientist Frank Thompson explains how Medicaid works, why the program has grown, and what forces have shaped both its durability and vulnerability. Timely, thoughtful, and thoroughly researched, this well-written book will inform anyone interested in health policy."—Eric M. Patashnik, professor of public policy and politics and associate dean of the Frank Batten School of Leadership and Public Policy, University of Virginia


Supplemental Materials


About the Author

Frank J. Thompson is a professor of public affairs and administration at Rutgers University–Newark and the Rutgers Center for State Health Policy in New Brunswick. Prior to joining Rutgers he served as dean of the Rockefeller College at the State University of New York in Albany. He is a fellow of the National Academy of Public Administration and has published extensively on matters of health policy. In 2007, Thompson received a Robert Wood Johnson Investigator Award to support his work on Medicaid.

288 pp., 6 x 9
3 figures, 12 tables
Sep 2012

288 pp., 6 x 9
3 figures, 12 tables
ISBN: 978-1-58901-934-8
Sep 2012

288 pp.
3 figures, 12 tables
ISBN: 978-1-58901-935-5
Sep 2012

American Governance and Public Policy series
Gerard W. Boychuk, Karen Mossberger, and Mark C. Rom, Series Editors

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