ABSTRACT
The 1990s have witnessed intense activity at the state level with respect to health care financing. This chapter describes the debate over Medicaid, discusses the constraints on policymakers’ ability to control program expenditures, and highlights Medicaid’s role in reducing the number of uninsured Americans. It considers issues states face in reforming the private insurance market and in regulating the health services market. The primary focus of health care financing at the state level is Medicaid. In the absence of major legislation at the federal level affecting Medicaid, most of the important policy developments will be through the earlier-mentioned Section 1115 Research and Demonstration waivers. Although Medicaid is obviously central to state budgets and health policy for the poor and near poor, private health insurance is crucial to the vast majority of citizens’ lives. Medical savings accounts are used in conjunction with catastrophic policies to provide an alternative to comprehensive health insurance policies.
