The New Politics of State Health Policy

With the collapse of national health care reform efforts in the early 1990s, states emerged as a focal point for new policy and administrative developments in U.S. health care. This book provides a timely overview of the key issues facing states as they have responded to this challenge. It tells how states are making decisions about health policies and then putting them into action—and how legislatures, executives, courts, and bureaucracies all participate in this process.

The New Politics of State Health Policy describes many of the major trends in states’ responses to health care problems of the 1990s, and it identifies the forces that will influence state policy actions in the new century. It examines reforms now under way, from Medicaid to tobacco control to mental health, and addresses today’s most pressing issues surrounding managed care, health insurance, and public health administration.

Editors Hackey and Rochefort have brought together a distinguished group of scholars and practitioners in the field of health policy analysis. Frank Thompson, Theodore Marmor, Michael Dukakis, and others map out the different institutional frames shaping how each state approaches the health care domain. While some states deliberate over universal coverage, others have shifted to the county level decisions once made in Washington, D.C. But all face the difficulty of taking on unprecedented responsibilities with limited resources amid the often-conflicting concerns of public management and “moral politics.”

Each contribution in the volume explores the interplay between state governance and health care policy by addressing four themes: the capacity of states to fulfill their new health care roles, the significance of recent policy changes, patterns in the politics of state health policy making, and the relationship of state-level changes to failed national health care reform. Together, they sound the call for stronger partnerships with both federal agencies and private sector organizations and the need for state officials to engage in broader, “outside-the-box” thinking.

As these essays show, health care policy can only be as good as the governments that make it. The New Politics of State Health Policy can help scholars, researchers, and practitioners better assess the programs and policy process in their own states in order to meet the demands of the health care marketplace on the one hand and public expectations on the other.