Ken WingFollow

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The political future may be difficult to predict with specificity, but surely the level of publicly-sponsored medical care for the poor will be severely reduced in the coming years, leaving millions of poor Americans to rely on the charitable capacity of the nation's health care providers-or simply to go without. What follows is an attempt to support this characterization of Medicaid and its political future. Section I of this article is a description of Medicaid, its structure prior to 1981, and the legal and political history of its development and implementation. In addition to providing the basis for understanding the potential impact of the proposed Medicaid changes, this section will emphasize the impact on the program of its larger political context and its relation to broader social and economic issues-forces that have sustained the program through two decades of controversy, but that have also imposed rather rigid restraints on its development. In Section II of this article, the original Reagan agenda for reordering federal spending priorities is summarized, with particular focus on Medicaid and other health-related programs. This discussion is followed by an analysis of the fate of the Reagan proposals through the political turmoil of the 97th Congress, and the eventual statutory and administrative changes in Medicaid brought about through the first half of the Reagan Administration. Section III assesses the initial impact of these changes and the probable effects on Medicaid for the next several years, as states react to the program changes and funding limitations imposed by the new federal order.