"As James Madison led America's effort to write its Constitution, he made two great inventions-the separation of powers and federalism. The first is more famous, but the second was most essential because, without federalism, there could have been no United States of America. Federalism has always been about setting the balance of power between the federal government and the states-and that's revolved around deciding just how much inequality the country was prepared to accept in exchange for making piece among often-warring states. Through the course of its history, the country has moved through a series of phases, some of which put more power into the hands of the federal government, and some rested more power in the states. Sometimes this rebalancing led to armed conflict. The Civil War, of course, almost split the nation permanently apart. And sometimes it led to political battles. By the end of the 1960s, however, the country seemed to have settled into a quiet agreement that inequality was a prime national concern, that the federal government had the responsibility for addressing it through its own policies, and that the states would serve as administrative agents of that policy. But as that agreement seemed set, federalism drifted from national debate, just as the states began using their administrative role to push in very different directions. The result has been a rising tide of inequality, with the great invention that helped create the nation increasingly driving it apart"--

The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.