Health Affairs, 24, no. 6 (2005): 1458-1466 doi: 10.1377/hlthaff.24.6.1458 © 2005 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Dimensions Of Change

Federalism And Health Policy

This paper presents a cyclical theory of U.S. federalism and social policy: Many social policy initiatives are tested and refined at the state level, especially during conservative periods, and later morph into national policies. The paper describes such federalism cycles and offers an interpretation of why and how they occur, focusing on Medicaid. State activism has preserved and expanded Medicaid through policy innovation and resistance to retrenchment, especially in conservative periods, by taking advantage of the flexibility the program provides. I conclude that Medicaid’s incremental/partnership approach is appropriate and feasible to build on for a future expansion of health care coverage.

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