Arbitrary access to care: the case for reforming Medicaid.

Abstract

Prologue: The enactment of Medicaid in 1965 represented a continuation of federal categorical aid to the needy started three decades earlier under the Social Security Act. In this essay, Tom Joe sets out the complexities and inequities of the federal-state Medicaid program as he has grown to know them intimately over a long career of social welfare policy analysis. Joes career in public policy took shape in the 1960s when he worked as a consultant to the California Assembly's Health and Welfare Committee. He followed California Republicans Robert Finch, who was the first secretary of health, education and welfare in the Nixon administration, and John Veneman, the department's undersecretary, to Washington in 1969. Working with Veneman, Joe was one of the architects of President Nixon s welfare reform plan. After departing government in 1972 and working as a private management consultant for five years, Joe created The Center for the Study of Social Policy, a small Washington-based think tank that feeds ideas and information to federal and state policymakers and private interests on a continuing basis. Joe is an acknowledged expert on government health and welfare programs. Most recently, he directed an examination of the Medicaid program that was undertaken by nine current or former directors of state Medicaid agencies and underwritten by The Robert Wood Johnson Foundation. The group recommended replacement of the Medicaid system with two basic programs: (l)a federally financed and administered National Primary Care Program and (2) a state-administered and federal-state financed Continuing Care Program that would provide a full range of health and social long-term services to dependent individuals with functional impairments. Judith Meltzer received her Master's degree at the University of Chicago and worked at the Department of Health, Education and Welfare Office of Planning and Evaluation as well as at Lewin and Associates before joining The Center for Social Policy as a senior research associate. Peter Yu is a research associate at the center.