MEDICAID AND COLLECTIVE ACTION

Objective. This study addresses the question of why there remain vastl y unequal Medicaid spending patterns across thr stairs, despite a fede ral reimbursement formula designed to mitigate these disparities. An i nterest group explanation oi Medicaid spending is developed to answer this question, using as a framework the pluralist and plural elitist m odels of group influence. Methods. A cross-sectional analysis oi Medic aid spending is performed on a Supplemental Security Income (SSI) cate gory model, an aid to Families with Dependent Children (AFDC) category model, and an overall model. Pertinent interest group variables are i ncluded to test hypothesis drawn from group theories. Results. Nursing home interest groups are found to bt extremely important for explaini ng Medicaid spending in all three models, while hospital groups and th e elderly are influential in the SSI and overall models. Physicians an d the poor do not significantly influence spending in any of the model s. Conclusions. The results lend support to the plural elitist theory of policymaking, in that small groups, or large groups providing their members with selective incentives, are found to be more influential t han large disorganized groups. The findings also point to the importan ce of distinguishing between different health care provider groups and different recipient categories when studying Medicaid.