Health Care for the Poor

Abstract

In the 1980s the convergence of a number of factors is causing government at all levels, industry, and labor to plan or initiate major reductions in health spending. Important among these are rising health care costs, a troubled national economy, mounting federal deficits and state revenue shortfalls, and the philosophical course and domestic policy of the Reagan administration. In this context government has been rethinking its capacity to finance health services for the poor, and new and sometimes controversial arrangements for delivering these services are being developed. The dilemma government officials face now is how to cut costs while still assuring that quality medical services are available. This article focuses on what these new policy developments and arrangements are and whether the significant gains in access and in health achieved over the past 20 years will be sustained. Because truly sweeping reforms are unlikely, whether government will maintain earlier commitments and established arrangements for financing and delivering health services to the poor will be worked out piecemeal over the next several years.

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References

1. For a more complete discussion, see John L. Palmer and Isabel V. Sawhill , eds., The Reagan Experiment (Washington, DC: Urban Institute, 1982); and John W. Ellwood , ed., Reductions in U.S. Domestic Spending: How They Affect State and Local Governments (New Brunswick, NJ: Transaction Books, 1982).

“Conflict is Found in Views on Needy” (Report sponsored by the Advisory Commission on Intergovernmental Relations), New York Times, 4 Feb. 1982.

3. For a broader discussion, see Drew E. Altman , “It Is Alas 1982,” Journal of Health Politics, Policy and Law, 7(1):271-280 (Spring 1982).

4. Drew E. Altman and Ruby P. Hearn , “Public Hospitals and Local Health Departments as Providers of Last Resort in an Era of Medicaid Cuts,” in New Approaches to the Medicaid Crisis, ed. Robert J. Blendon and Thomas W. Moloney (New York: Frost and Sullivan, forthcoming).

5. For statistics on the Medicaid program, see Department of Health and Human Services , Health Care Financing Program Statistics 1981 (Washington, DC: DHHS, Health Care Financing Administration, Office of Research and Demonstrations, 1982).

Thomas W. Moloney , What's Being Done about Medicaid? A Commonwealth Fund Paper (New York: Commonwealth Fund, 1982).

7. Altman and Hearn , “Public Hospitals and Local Health Departments.”

8. Theodore Marmor , The Politics of Medicare (Chicago: Aldine, 1970).

9. For a broader discussion, see Robert Haveman , ed., A Decade of Federal Anti-Poverty Programs: Achievements, Failures, and Lessons (New York: Academic Press, 1977); see also Peter Marris and Martin Rein , Dilemmas in Social Reform (Chicago: Aldine, 1973); and Daniel P. Moynihan , Maximum Feasible Misunderstanding (New York: Free Press, 1970).

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National Center for Health Statistics , Vital and Health Statistics, series 10 (Washington, DC: Government Printing Office, 1976); Department of Health, Education and Welfare, Public Health Service , Health U.S. 1975 (Hyattsville, MD: DHEW, 1975); National Center for Health Statistics , Monthly Vital Statistics Report 1980, DHHS pub. no. (PHS) 81-1120, 29(13): 1-31 (1981).

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11. Rogers , Blendon , and Moloney , “Who Needs Medicaid?”

12.

12. Robert M. Gibson and Daniel R. Waldo , “National Health Expenditures, 1980,” Health Care Financing Review, 3(1): 1-37 (Sept. 1981).

13.

13. Palmer and Sawhill , eds., Reagan Experiment, p. 63.

14.

14. Ibid., p. 171.

15.

15. Rogers , Blendon , and Moloney , “Who Needs Medicaid?”

16.

16. For a full discussion of the options, see Blendon and Moloney , eds., New Approaches to the Medicaid Crisis.

17.

17. Intergovernmental Health Policy Project , Georgetown University, State Health Notes, 30 (Oct./Nov. 1982).

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18. Rogers , Blendon , and Moloney , “Who Needs Medicaid?”

19.

see also “The State Rate Setting Model—Long Range Solution or Short Term Experiment? A Forum on State Rate Setting,” Health Affairs (Summer 1982).

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20. ICF, Inc. , “Background Data on Changes in Hospital Expenditures and Revenues, 1970-1980” (Unpublished report, 1982).