MEDICAID AND THE POLITICS OF GROUPS - RECIPIENTS, PROVIDERS, AND POLICY-MAKING

There is a substantial heterogeneity of interests within the Medicaid program. Its major beneficiary groups include the elderly, people with disabilities, children in low-income families, and adults receiving A id to Families with Dependent Children. Providers who deliver medical services to these recipients represent another set of potential claima nts. These groups are Likely to be treated differently by the politics that affect the design and management of the Medicaid program. The Me dicaid recipient groups vary in several important dimensions: First, t he groups differ politically, a dimension that includes their politica l participation, their relationships to parties and electoral coalitio ns, the images they present to other political actors, and the legacy of public policies that affect them. Second, the groups have different medical and social needs. Third, the groups differ with respect to ec onomic constraints, including the political economy of labor markets a nd of government spending programs, and they have differing relationsh ips to the various types of medical providers. The medical providers a re themselves political actors with a variety of characteristics that create political advantages relative to recipients, although there is also diversity among providers. The politics of the Medicaid program i nvolves more than simply technical decisions about eligibility, covera ge of medical services, reimbursement, and the implementation of manag ed care initiatives. Instead the differences between the program's mul tiple claimants are an important element of current Medicaid politics and the likely path of future reforms.