ABSTRACT
Omnibus Budget Reconciliation Act of 1981 was the first great victory of the Ronald Reagan administration, as well as the moving cause of a number of subsequent developments. It was a defining episode: setting the major issues and establishing the modes of dispute and resolution in a number of domestic policy areas. Consolidated Omnibus Budget Reconciliation allowed states to cover hospice care for terminally ill Medicaid recipients; and Sixth Omnibus Budget Reconciliation allowed states that already covered pregnant women and children to extend Medicaid to elderly and disabled persons who were below the poverty level but above Supplemental Security Income limits. Disproportionate share funds were established for Medicaid hospitals in 1981 as part of the Boren Amendment, as a way to compensate and help sustain hospitals serving large numbers of Medicaid and/or no-pay patients. The Medicare Catastrophic Coverage Act of 1988 was instance in which legislation about national health insurance or Medicare had large, unintended, and detrimental consequences for Medicaid.
