Healthy Voices, Unhealthy Silence: Advocacy and Health Policy for the Poor

By Colleen M. Grogan; Michael K. Gusmano | Go to book overview

5
Medicaid's Policy Network
and the Ties that Bind
NONPROFIT ADVOCACY AND SOCIAL INTERACTIONS

Concerns about the state's budget, a political climate that made it difficult to criticize the new program, a lack of data to measure mainstreaming, and specific solutions that diverted attention from larger issues all contributed to the public silence over mainstream Medicaid access in Connecticut. Yet as we concluded in the previous chapter, these factors were not enough to prevent advocates for the poor from discussing equally tricky issues such as the state's capitation rate or quality assurance, so there must be other reasons for the striking absence of public debate. To fill in the missing pieces of the public silence puzzle, it is crucial to understand how MMC reform itself changed participants' interests and social interactions within the policy network. These changes significantly hindered the ability of advocates to represent the interests of the poor on the issue of mainstream access.

If we look closely at the participants of Connecticut's public forums, we find that three of the six main groups included— Medicaid providers, Medicaid advocates, and Medicaid consumer representatives—have extensive experience with poor children and their families enrolled in the Medicaid program, and they all have a strong and integral tie to the world of nonprofit health and social service organizations. Even many participants from the other three groups—health plan representatives, state legislators, and representatives of state agencies—have longstanding ties to nonprofit health care organizations. The main reason for these ties stems from private physicians' lack of willingness to care for Medicaid recipients and the state government's consequent reliance

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