This is the last in a series of three posts. I’ve proposed three approaches that Republicans might use to get out of the dilemma they are in over health care:
- Universal catastrophic coverage (Part 1)
- Universal safety net (Part 2)
- Responsible federalism (Part 3)
The Case for a Responsible Federalism
We have had federalism in health care for many decades. The grandaddy of them all is the open-ended Medicaid program which obligates Uncle Sam to pony up federal matching dollars in lock-stop with state willingness to put up their dollars. As AEI health policy expert Joe Antos recently pointed out, Medicaid has needed fixing for 50 years. But even before that we have had federal grant-in-aid programs dating back to the 1930’s that channeled federal dollars into health care. In my view, responsible federalism in health care would entail reforming the perverse fiscal incentives embedded in Medicaid while also offering states much greater flexibility to solve their health problems without the heavy hand of Uncle Sam.
HENRY KOTULA 