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The States as Generators of Incremental Change in American Health Care Policy: 1935 to 1965
Abstract
The literature defines the role of interest groups and administration officials in the evolution of health care policy but does not acknowledge the impact of Congressional casework or the initial Social Security (OASI) eligibility criteria. There is, as a result, an inadequate appreciation for (1) the extent to which the initial development of federal policy was a function of Congressional delegations pursuing initiatives that would increase the flow of federal dollars their states could use to expand health services or (2) the way in which the regional cleavages created OASI eligibility criteria combined with the South's control of Congressional leadership positions to yield an expansion of health care for indigent people while intentionally delaying the creation of Medicare. This chapter addresses these gaps and provides a more complete picture of the way in which the incremental, unplanned evolution of federal health care policy was the product of using federal resources to diminish the states' fiscal needs and the south's capacity to temporarily control the health care agenda.
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