The Federal-State Relationship in Health Care Reform: A View from the Trenches

The advent of Medicare and Medicaid in the mid-1960s dramatically changed the dynamics of health care policy. The Medicare program was designed to provide assistance to states in paying for the health care costs of those families on the federal-state welfare program, as well as to low-income elderly, blind, and disabled persons. Medicaid is a federal-state partnership in which the national government matches state expenditures for services provided to Medicaid-eligible clients. During the 1989 legislative session, a political consensus formed among a broad array of interest groups to develop and pass comprehensive health reform. Both the tax credit program and high-risk pool were initiatives we could undertake without federal approval. The initial major undertaking, however, involved the reform of the Medicaid program. The center of the controversy over Oregon&s;s plan was with our proposal to determine benefits based on a priority list of health services.