Will All Health Care Reform Lead Back to Medicaid?

During the U.S. presidential campaign, the Republican and Democratic candidates proposed health care reform plans that emphasized reducing the number of uninsured Americans—approximately 45 million people younger than 65 years have no health care coverage. Their plans also focused on controlling health care costs, which consume 16% of the nation's gross domestic product, far more than that of any other developed country. The candidates promised to make health care reform a priority.

But what happens if health care reform loses its place on the president's priority list? This is a real possibility, according to Michael Sparer, JD, PhD, professor of health policy and management at Columbia University in New York. Sparer noted that interest group politics, political culture, and institutional dynamics will probably thwart comprehensive national health care reform. “Powerful interest groups could once again derail any move toward major reform. The nation's antigovernment political culture is again going to be a powerful obstacle. And institutionally, the new president is going to have to deal with the number 1 priority, the economy, and the number 2 priority, the war. Health care is going to be a distant third,” he said.

Those realities do not mean that the political will for health care reform will go away, just that it might remain stuck at status quo—at the state level and centered on Medicaid expansion. The Kaiser Family Foundation reported that of 42 states planning health coverage expansion in 2007 and 2008, 38 planned to use Medicaid to support these efforts (1). In recent years, Massachusetts, Vermont, and other states have relied largely on Medicaid funds to expand health care coverage. “Since no dramatic health reform programs are likely to be enacted in this kind of environment, Medicaid becomes even larger and more important. It is really the only path to …