The Politics of Medicaid

Wow! A book that does exactly what its title promises--captures the politics of the policy of Medicaid. No other work does so as comprehensively and with such sharp insight and purpose. Laura Katz Olson weaves every detail into an overarching struggle between those who would strengthen Medicaid's ability to provide health care for the poor and those who would weaken it. The Politics of Medicaid will be the bible for political scientists and policy analysts alike. -- Deborah Stone, Dartmouth College In a deftly crafted chef d'oeuvre, Laura Katz Olson shines a lantern on the largest medical insurance plan in the land. Though Medicaid accounts for a full 7 percent of the federal budget, it remains the stepchild of welfare provisions in the United States, and perceptions of it provide a looking glass into American values. Getting past the surlies in managed-care companies often places those in need on the outside looking in, subjected to the invisible foot of the medical marketplace. Olson's savvy analysis of medical welfare's arcane policies reminds readers that many of us are but one crushing medical bill away from the same fate. Her insights paint Medicaid as a bit of a shell game between federal and state policies, one that would make Rube Goldberg proud. Truly a medalist performance and a must read as we take the next step toward national coverage. -- Jon Hendricks, Oregon State University In this fascinating and beautifully written book, Laura Katz Olson untangles the complex web of policies and programs that make up Medicaid, the least understood program in the American welfare state. The timing couldn't be better, because Medicaid expansion is a key component of health care reform. Although the uninsured will certainly benefit, Olson makes clear that the providers and contractors who feed off the 'medical industrial complex' may benefit even more. The Politics of Medicaid should be required reading for every health policy course. -- Jill Quadagno, Pepper Institute on Aging and Public Policy, Florida State University

In 1965, the United States government enacted legislation to provide low-income individuals with quality health care and related services. Initially viewed as the friendless stepchild of Medicare, Medicaid has grown exponentially since its inception, becoming a formidable force of its own. Funded jointly by the national government and each of the fifty states, the program is now the fourth most expensive item in the federal budget and the second largest category of spending for almost every state. Now, under the new, historic health care reform legislation, Medicaid is scheduled to include sixteen million more people. Laura Katz Olson, an expert on health, aging, and long-term care policy, unravels the multifaceted and perplexing puzzle of Medicaid with respect to those who invest in and benefit from the program. Assessing the social, political, and economic dynamics that have shaped Medicaid for almost half a century, she helps readers of all backgrounds understand the entrenched and powerful interests woven into the system that have been instrumental in swelling costs and holding elected officials hostage. Addressing such fundamental questions as whether patients receive good care and whether Medicaid meets the needs of the low-income population it is supposed to serve, Olson evaluates the extent to which the program is an appropriate foundation for health care reform.