Consequential drift: the government program where party differences have widened the most, and matter the most, is Medicaid.

• Author: Kilgore, Ed
• Position: Medicaid Politics: Federalism, Policy Durability, and Health Reform - Book review

Medicaid Politics: Federalism, Policy Durability, and Health Reform

by Frank J. Thompson

Georgetown University Press, 288 pp.

On June 28, 2012, when the U.S. Supreme Court announced its decision in the case of National Federation of Independent Business v. Sebelius, the happiness of progressives over the upholding of the Affordable Care Act's individual health insurance purchasing mandate was accompanied by a rare moment of dismay over the Court's treatment of provisions affecting Medicaid. Long called "Medicare's poor second cousin," the principal federal-state program supplying health care for the poor and disabled (and long-term care for the improvident elderly) had been transformed by the ACA, from being a stopgap and sloppily designed entitlement destined to be ultimately supplanted by a universal health care initiative into a key element of health care reform.

With the Court's ruling that the ACA's expansion of Medicaid would be optional rather than mandatory for the states, the program was thrust into the spotlight of national politics, where it remains today as Republican-controlled states seek to thwart Obamacare by rejecting the Medicaid expansion. There were even brief moments when Medicaid served as an issue during the 2012 presidential campaign, albeit a minor one when compared with the constant references to each party's thrusts and parries over Medicare, considered the most politically crucial existing health care program.

For those with a special concern over the fate of low-income Americans, and for the states in whose budgets Medicaid is typically the weightiest item, the emergence of Medicaid as what the vice president would call a "BFD" was long overdue. But for everyone else, a crash remedial course in the ever-evolving history, arcane structure, and multidimensional politics of the program has become essential. It is largely supplied by Medicaid Politics: Federalism, Policy Durability, and Health Reform, a new book by Rutgers professor Frank J. Thompson.

Thompson's book focuses on the period from the beginning of the Clinton administration through most of Barack Obama's first term. Its sustaining concern is explaining how a program with so many flaws and anomalies--widely varying levels of funding and commitment among the states, an early unsavory reputation as second-class "welfare medicine," disparate and often competing constituencies, and an occasionally receding but eventually powerful hostility from the...