Governing Partners: State-Local Relations in the United States

By Russell L. Hanson | Go to book overview

10
The Politics of State Health and Welfare Reforms

Charles Barrilleaux

State governments directly touch the lives of citizens through their health and welfare policy packages. State decisions determine the types of health care services that are delivered within a state, influence the type and number of facilities that are available, establish the methods by which professionals receive licensure, and for the poor, determine who has, and does not have, insurance coverage and what services that insurance covers. Welfare policy choices determine who receives how much assistance and also provide a gateway for the receipt of state-sponsored health insurance coverage. Recent demands for health and welfare reform will significantly alter the status quo in each area, and current calls for a reduced national government role in setting the rules for health and welfare coverage, along with a shift to block grants in lieu of existing methods of federal contribution, will force the states to introduce innovations to their methods of providing both health and welfare coverage in the future.

The term "health policy" is confusing since no American state, let alone the nation, has a single identifiable policy. Instead, health policies in the states are a jumble of often contradictory rules and pieces of legislation that seldom add up to a meaningful whole. Politics leads states to do seemingly illogical things. Florida invests large sums of money to improve prenatal and neonatal care for the poor in hope of improving birth outcomes, yet the state is reluctant to provide birth control information in schools due to resistance from conservatives. North Carolina seeks to strike information regarding the hazards of smoking during pregnancy from materials provided to pregnant women because tobacco interests take exception to the information. Legislators in a number of states seek to reduce the costs of trauma care yet they also support raising speed limits even though there is strong evidence that reducing them will decrease

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Governing Partners: State-Local Relations in the United States
Table of contents

Table of contents

  • Title Page v
  • Contents vii
  • Tables and Figures ix
  • Preface xi
  • 1 - The Interaction of State and Local Governments 1
  • 2 - The Intergovernmental Setting of State-Local Relations 17
  • Notes 36
  • 3 - State-Local Relations: Union and Home Rule 37
  • Notes 51
  • 4 - Emerging Trends in State-Local Relations 53
  • Notes 74
  • 5 - The Politics of State-Local Fiscal Relations 75
  • 6 - Partners for Growth: State and Local Relations in Economic Development 93
  • Notes 106
  • 7 - The State-Local Partnership in Education 109
  • Notes 137
  • 8 - Environmental Regulation and State-Local Relations 139
  • Notes 159
  • 9 - Untidy Business: Disaggregating State-Local Relations 161
  • 10 - The Politics of State Health and Welfare Reforms 177
  • Notes 198
  • References 199
  • About the Editor 213
  • About the Contributors 215
  • Index 217
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