Back to the Future? Health Benefits, Organized Labor, and Universal Health Care

This study investigates the factors that underlie large variation in Medicaid and Children's Health Insurance Program (CHIP) policies among states. Both eligibility and provider payment policies are examined for low-income children and parents. I find that state variation in the cost of providing health care, due to variation in the intensity of health care use, is a key determinant of eligibility policies, and I also find tentative evidence of an effect for payment policies. Because rising health care spending increases the cost of providing health insurance coverage, state policy makers in high-spending states enact less generous Medicaid and CHIP policies. Results also indicate that the political environments of states are very important in determining their eligibility policies, but fewer political variables influence payment policies. In addition to including variables not yet examined in the context of Medicaid policy, this study uses an innovative measure of state-level health care spending and carefully constructed dependent variables that lend credibility to causal interpretations of relationships.

Section: State Politicsmentioning

confidence: 99%

State Variation in Health Care Spending and the Politics of State Medicaid Policy

Lukens

2014

“…A small portion of this decline is due to the expansion of public health insurance coverage, particularly the State Children's Health Insurance Program (SCHIP), but most of the decline is due to increases in health insurance premiums (Reschovsky, Strunk, and Ginsburg 2006). In addition to this decline among current workers, several employers have reduced or eliminated retiree health benefits (Gottschaulk 2007).…”

Section: A Brief Overview Of Two Health Systemsmentioning

confidence: 99%

Health Care for Older Persons in England and the United States: A Contrast of Systems and Values

Gusmano¹,

Allin²

2011

This article extends previous comparisons of access to health care for older persons in England and the United States by comparing rates of avoidable hospital conditions as a proxy for primary care access and by examining the distribution of care within these older populations. Drawing on hospital data from the two countries, we find that older persons in the United States, particularly those over the age of seventy-five, receive far more revascularizations than do older persons in England. Differences in the use of lower-joint replacement are not as great, but we are unable to assess differences in the need for these procedures. Although older persons have greater access to specialty care in the United States, there appears to be much better access to primary care in England. We are unable to draw comparisons on the extent of inequalities in access to health care, although in the United States there is evidence of inequalities in access by race, and in England we confirm earlier studies that find inequalities by level of deprivation. These findings are discussed in the context of the political debates over access to care and rationing in the two countries.

“…Ruger (2007) argues that fundamental differences in the high-level principles that average Americans hold allow opponents of policy reform to use wedges to break apart proposed coalitions for change. And Gottschalk (2007) notes that such fissures extend not only across political parties but also to different camps within organized labor. posals are instead coming from the more extreme and divisive actors in American politics.…”

Section: Institutional Gridlock Hypothesis Congressional Institutionsmentioning

confidence: 99%

Breaking Gridlock: The Determinants of Health Policy Change in Congress

Volden

Wiseman²

2011

Prior to the 2010 health care reforms, scholars often commented that health policy making in Congress was mired in political gridlock, that reforms were far more likely to fail than to succeed, and that the path forward was unclear. In light of recent events, new narratives are being advanced. In formulating these assessments, scholars of health politics tend to analyze individual major reform proposals to determine why they succeeded or failed and what lessons could be drawn for the future. Taking a different approach, we examine all health policies proposed in the U.S. House of Representatives between 1973 and 2002. We analyze these bills' fates and the effectiveness of their sponsors in guiding these proposals through Congress. Setting these proposed policies against a baseline of policy advancements in other areas, we demonstrate that health policy making has indeed been far more gridlocked than policy making in most other areas. We then isolate some of the causes of this gridlock, as well as some of the conditions that have helped to bring about health policy change.