WASHINGTON, D.C., July 22, 2003—As states contend with unprecedented deficits and the Congressional Budget Office projects that Medicaid costs will increase an average of 8.5 percent annually over the coming decade, the Urban Institute Press offers policymakers, practitioners, and scholars the deepest, broadest review to date of the changing health safety net.
Federalism and Health Policy, edited by John Holahan, Alan Weil, and Joshua M. Wiener with chapters by many of the nation's leading health policy researchers, analyzes the balance of responsibility—financial, administrative, and oversight—between Washington and the states in delivering health care to low-income and uninsured individuals. The book also explores alternative allocations of responsibility for Medicare, the State Children's Health Insurance Program, health insurance regulations, and patient protection laws.
The book appears as cash-strapped states are calling for fiscal relief and the White House is proposing voluntary block grants that pair increased flexibility with predetermined levels of federal funds. Meanwhile, the number of Americans without health insurance grew in 2001 after two years of decline and is expected to show another jump in 2002.
"The balance of federal and state responsibilities has achieved a great deal. But it has failed to insure 40 million Americans, it expands coverage in small steps only, and under it no state, much less the nation as a whole, has developed a comprehensive approach to covering the uninsured," say Holahan, Weil, and Wiener. "Indeed, the late 1990s may turn out to have been the high-water mark for health insurance coverage within the parameters of the current system."
The Book in Brief
Federalism and Health Policy is the latest work from the Urban Institute's Assessing the New Federalism project. The seven-year-old initiative, directed by Alan Weil, analyzes the devolution of health and income support programs to the states. John Holahan is director of the Urban Institute's Health Policy Center. Joshua M. Wiener, formerly with the Health Policy Center, is a fellow and the director of the Aging, Disability, and Long-Term Care Program at RTI International.
The 446-page book's dozen chapters and their authors include:
1. "Federalism and Health Policy: An Overview," by John Holahan, Alan Weil, and Joshua M. Wiener
2. "State and Federal Roles in Health Care: Rationales for Allocating Responsibilities," by Randall R. Bovbjerg (Urban Institute), Joshua Wiener, and Michael Housman (Lewin Group)
3. "Health Care within the Larger State Budget," by Donald J. Boyd (Rockefeller Institute of Government)
4. "Variation in Health Insurance Coverage and Medical Expenditures: How Much Is Too Much?" by John Holahan
5. "States' Strategies for Tapping Federal Revenues: Implications and Consequences of Medicaid Maximization," by Teresa A. Coughlin (Urban Institute) and Stephen Zuckerman (Urban Institute)
6. "Leaders and Laggards in State Coverage Expansions," by John Holahan and Mary Beth Pohl (Urban Institute)
7. "Medicaid Managed Care: State Flexibility in Action," by Robert E. Hurley (Virginia Commonwealth University) and Stephen Zuckerman
8. "Long-Term Care: Can the States Be the Engine of Reform?" by Joshua Wiener and Jane Tilly (Urban Institute)
9. "The State Children's Health Insurance Program: A New Approach to Federalism," by Alan Weil and Ian Hill (Urban Institute)
10. "Making Medicaid a National Program: Medicare As a Model," by Marilyn Moon (American Institutes for Research, previously with Urban Institute)
11. "Alternative Models of Federalism: Health Insurance Regulation and Patient Protection Laws," by Randall R. Bovbjerg
12. "Improving the Federal System of Health Care Coverage," by Alan Weil, John Holahan, and Joshua Wiener
"Both the federal and state governments are reluctant to extend Medicaid to other uninsured populations and to aggressively change the balance of services in long-term care," say Holahan, Weil, and Wiener. "Because of the large fiscal shortfalls they will face for the foreseeable future, states may not even be able to maintain their current levels of coverage and benefits. The innovations and the will to expand coverage that are analyzed in this book are probably as good as it gets, which leaves huge chunks of the population uninsured and without adequate services."
Ahead from Assessing the New Federalism and the Health Policy Center
On July 31, the Urban Institute will issue "Children's Insurance Coverage and Service Use Improve" and "Familiarity with SCHIP and Medicaid Grows and Interest in Enrolling Is High," both by Genevieve Kenney, Jennifer Haley, and Alexandra Tebay. The two publications are products of Snapshots of America's Families III, a first look at data from the Urban Institute's 2002 round of the National Survey of America's Families. Later Snapshots will include analyses of adult health coverage trends by Stephen Zuckerman and John Holahan.
Federalism and Health Policy, edited by John Holahan, Alan Weil, and Joshua M. Wiener, is available from the Urban Institute Press (446 pages, ISBN 0-87766-716-0, $34.50). To order, call (202) 261-5687 or toll-free 1-877-847-7377. The work was supported by the Robert Wood Johnson Foundation and other funders of the Assessing the New Federalism project: the Annie E. Casey, W. K. Kellogg, John D. and Catherine T. MacArthur, and Ford Foundations.
The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic, and governance challenges facing the nation.
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