The Politics of State Health and Welfare Reforms
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