Cultural, Social, and Political Influences on State-Level Indigent Health Care Policy Formation

Abstract

Using a state-culture conceptual framework, this 50-state study of the United States identifies factors affecting state-level variance in Medicaid expenditures in 2004. Path analysis is applied to depict a structural model measured by political and socioeconomic predictors of state-level Medicaid expenditures. Findings show Democratic political party control, and a state's financial capacity predicts higher Medicaid expenditures. Medicaid need demographics have a significant, but negative, effect on Medicaid expenditures. Maintaining political neutrality may constrain our ability to advocate for vulnerable populations. Establishing a uniform standard for indigent health care through a federally financed and administered universal health insurance structure is discussed.

KEYWORDS:

• Medicaid
• state-culture framework
• state-level health policy formation
• political party control
• role of government

An earlier version of this article was presented at the 12th Annual Conference of the Society for Social Work and Research at Washington DC., where we received important feedback from attendees. We also are grateful to Drs. Robert Moroney, Elizabeth Segal, Robert Leighninger, and Kevin Corcoran for their helpful comments on earlier drafts.

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