Chapter 8
State Governments: E Pluribus Multa
Howard Leichter
© 2008 Delmar Cengage Learning.
States and Health Care:
Protecting the Public’s Health
• Since mid-19th century
– States have taken the lead in monitoring the
health conditions amongst their citizens
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© 2008 Delmar Cengage Learning.
States and Health Care:
Protecting the Public’s Health
• States are largely responsible for the
control and, where possible, elimination of
microbial and airborne substances that can
give rise to ill health
– The latter is of particular significance in the
wake of 9/11
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© 2008 Delmar Cengage Learning.
States and Health Care:
Providing a Health Safety Net
• Through such institutions as state hospitals
and divers funding programs (including, but
not limited to, Medicaid)
– States are responsible for providing health
care to those left behind by the fee-for-service
health care service
– Or those generally unable to fend for
themselves
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States and Health Care:
Supervising the Medical Profession
• Through Boards of Health
– States are responsible for the licensure of
medical professionals
• Effectively regulating the profession
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States and Health Care:
Regulating the Insurance Industry
• States are responsible for regulating the
health insurance industry within their
borders
– Determine whom they must cover
– Benefits they are to provide
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States and Health Care:
Regulating the Insurance Industry
• This task has been made more difficult with
the passage of ERISA (1974)
– Drastically limits the state regulatory role in
self-insuring firms and the plans they provide
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States and Health Care Diversity:
Demographics
• States vary significantly in terms of their
demographic characteristics
– Impacts the nature of the health care system to
be found in each
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© 2008 Delmar Cengage Learning.
States and Health Care Diversity:
Demographics
• Factors that can influence health and
health care:
– Rural/urban character of a state
– Levels of poverty
– Racial/ethnic profile
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© 2008 Delmar Cengage Learning.
States and Health Care Diversity:
State Health Profile(s)
• Conditions within certain states (including
demographic characteristics)
– Can contribute to different patterns of ill (and
good) health
– Affect range of ailments encountered
• Distribution across the state
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© 2008 Delmar Cengage Learning.
States and Health Care Diversity:
Access to Care
• States differ considerably when it comes to
the ease with which their citizens can
access care
• Factors that can influence access to care:
– Economic health of states
– Population distribution
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© 2008 Delmar Cengage Learning.
States and Health Care Diversity:
Political Culture
• Depending on the predominant political
traditions and beliefs found among citizens
– Some states simply tend to be more innovative
and/or generous in the field of social welfare
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© 2008 Delmar Cengage Learning.
States and Health Care Diversity:
Political Culture
• Elazar et. al.
– Offer geographically-dispersed political
cultures that affect policies/political structures
found in each area
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© 2008 Delmar Cengage Learning.
Medicaid:
The 900-Pound Gorilla
• As outlined in previous chapter:
– Federal and state governments provide health
care coverage to:
• The poor
• Many children
• Those suffering from certain conditions (including
HIV/AIDS)
• Two-thirds of those receiving nursing home care
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© 2008 Delmar Cengage Learning.
Medicaid:
The 900-Pound Gorilla
• State contribution toward Medicaid often
comprises a full one-fifth of the overall
(state) budget(!)
• Funding crunches are common:
– Just when state revenue is contracting during
bad economic times, the numbers requiring
benefits under Medicaid tend to rise
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© 2008 Delmar Cengage Learning.
Medicaid:
The 900-pound Gorilla
• Many states offer benefits for groups
ineligible for Medicaid
– But unable to acquire coverage on the private
market
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© 2008 Delmar Cengage Learning.
Chapter 8 Summary
• States play broad and varied role in health
care:
– Monitoring public health
– Providing a health “safety net” for the less
fortunate (and uninsured)
– Licensing members of the medical profession
– Regulating health insurers
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© 2008 Delmar Cengage Learning.
Chapter 8 Summary
• Several variables determine the precise
nature of health services in a given state:
– Demographics
– State health profile
– Access to health care
– Political culture
• Medicaid
– The states’ “900-pound gorilla”
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© 2008 Delmar Cengage Learning.