© 2008 Delmar Cengage Learning. Chapter 8 State Governments: E Pluribus Multa Howard Leichter

© 2008 Delmar Cengage Learning. 2 States and Health Care: Protecting the Public’s Health Since mid-19 th century –States have taken the lead in monitoring the health conditions amongst their citizens

© 2008 Delmar Cengage Learning. 3 States and Health Care: Protecting the Public’s Health States are largely responsible for the control and, where possible, elimination of microbial and airborne substances that can give rise to ill health –The latter is of particular significance in the wake of 9/11

© 2008 Delmar Cengage Learning. 4 States and Health Care: Providing a Health Safety Net Through such institutions as state hospitals and divers funding programs (including, but not limited to, Medicaid) –States are responsible for providing health care to those left behind by the fee-for-service health care service –Or those generally unable to fend for themselves

© 2008 Delmar Cengage Learning. 5 States and Health Care: Supervising the Medical Profession Through Boards of Health –States are responsible for the licensure of medical professionals Effectively regulating the profession

© 2008 Delmar Cengage Learning. 6 States and Health Care: Regulating the Insurance Industry States are responsible for regulating the health insurance industry within their borders –Determine whom they must cover –Benefits they are to provide

© 2008 Delmar Cengage Learning. 7 States and Health Care: Regulating the Insurance Industry This task has been made more difficult with the passage of ERISA (1974) –Drastically limits the state regulatory role in self-insuring firms and the plans they provide

© 2008 Delmar Cengage Learning. 8 States and Health Care Diversity: Demographics States vary significantly in terms of their demographic characteristics –Impacts the nature of the health care system to be found in each

© 2008 Delmar Cengage Learning. 9 States and Health Care Diversity: Demographics Factors that can influence health and health care: –Rural/urban character of a state –Levels of poverty –Racial/ethnic profile

© 2008 Delmar Cengage Learning. 10 States and Health Care Diversity: State Health Profile(s) Conditions within certain states (including demographic characteristics) –Can contribute to different patterns of ill (and good) health –Affect range of ailments encountered Distribution across the state

© 2008 Delmar Cengage Learning. 11 States and Health Care Diversity: Access to Care States differ considerably when it comes to the ease with which their citizens can access care Factors that can influence access to care: –Economic health of states –Population distribution

© 2008 Delmar Cengage Learning. 12 States and Health Care Diversity: Political Culture Depending on the predominant political traditions and beliefs found among citizens –Some states simply tend to be more innovative and/or generous in the field of social welfare

© 2008 Delmar Cengage Learning. 13 States and Health Care Diversity: Political Culture Elazar et. al. –Offer geographically-dispersed political cultures that affect policies/political structures found in each area

© 2008 Delmar Cengage Learning. 14 Medicaid: The 900-Pound Gorilla As outlined in previous chapter: –Federal and state governments provide health care coverage to: The poor Many children Those suffering from certain conditions (including HIV/AIDS) Two-thirds of those receiving nursing home care

© 2008 Delmar Cengage Learning. 15 Medicaid: The 900-Pound Gorilla State contribution toward Medicaid often comprises a full one-fifth of the overall (state) budget(!) Funding crunches are common: –Just when state revenue is contracting during bad economic times, the numbers requiring benefits under Medicaid tend to rise

© 2008 Delmar Cengage Learning. 16 Medicaid: The 900-pound Gorilla Many states offer benefits for groups ineligible for Medicaid –But unable to acquire coverage on the private market

© 2008 Delmar Cengage Learning. 17 Chapter 8 Summary States play broad and varied role in health care: –Monitoring public health –Providing a health “safety net” for the less fortunate (and uninsured) –Licensing members of the medical profession –Regulating health insurers

© 2008 Delmar Cengage Learning. 18 Chapter 8 Summary Several variables determine the precise nature of health services in a given state: –Demographics –State health profile –Access to health care –Political culture Medicaid –The states’ “900-pound gorilla”