ABSTRACT
Medicare as a single-payer, federally administered entitlement is in a category by itself, because of the degree of federal involvement and Medicare’s symbolic and strategic importance. Medicare politics from 1995 to the present demonstrates that such an effort provokes an enormous amount of organized resistance and legislative conflict. Trends in managed care are one such destabilizing factor. Earlier policy proposals for major structural changes in the Medicare program have assumed that HMOs would, in principle, save money for Medicare, earn a surplus, and aggressively recruit Medicare enrollees. The governors’ plan would have used Section 1115 waivers to extend coverage to the unemployed by reducing optional Medicaid benefits and collecting an enhanced match from the federal government. The fiscal effect would be to shift resources from Medicaid programs to benefit the unemployed and to channel quite a large amount of money from the federal government to the states.
