Medicaid has grown to be the largest intergovernmental grant program in the United States, thanks in part to the efforts of state governors
Medicaid has evolved over the past five decades from a tiny "welfare medicine" program into the single largest health insurance program in the United States. Contrary to the conventional wisdom that programs for the poor are vulnerable to instability and retrenchment because they lack a powerful constituency, Shanna Rose finds that, as a result of its unique institutional structure, Medicaid does, in fact, have an organized, influential interest group: the nation's governors. Although governors routinely criticize Medicaid for its mounting cost to the states, they have found it difficult to resist the powerful expansionary incentives created by the program's open-ended matching grants. Throughout the program's history, state leaders have used a variety of methods ranging from lobbying and negotiation to creative financing mechanisms and waivers to maximize federal aid, thereby fueling Medicaid's growth. And, perceiving federal retrenchment efforts as a threat to states’ financial interests, the governors have repeatedly worked together in bipartisan fashion to defend the program against cutbacks. Indeed, Rose argues, Medicaid has been a driving force behind the mobilization of the intergovernmental lobby, and specifically the National Governors Association—one of the most powerful interest groups in Washington. Financing Medicaid engagingly intertwines theory, historical narrative, and case studies, drawing on a variety of sources including archival materials from gubernatorial and presidential libraries and the National Governors Association.
“Rose offers a penetrating, detailed analysis of one of the most remarkable and surprising developments in U.S. health policy over the past half century: the transformation of Medicaid from a modest program for welfare families into the nation’s largest entitlement after Social Security.”
—Eric Patashnik, Frank Batten School of Leadership and Public Policy, University of Virginia