Medicaid and the Politics of Redistribution

Abstract

Previous analyses of state welfare policymaking have emphasized the of welfare spending or related measures of policy activity. However, if we shift our attention to the program decisions that lie behind expenditure measures, it becomes obvious that determinants actually operate as constraints on policymakers' behavior. As such they limit policymakers, but within these limits a certain amount of decisionmaking latitude still exists. The extent of that latitude, the uses to which it is put, and to a lesser extent the effect of its exercise are the subject of this investigation, which focuses on state Medicaid programs.