POSC 459 — Social Welfare Politics and Policy · Week 7, Wednesday 7 October 2026
Accessible text version of the Week 7 Wednesday slides — same content in linear order, with no slide-scaling container. Reading: Grogan and Andrews (2014); Howard (2007), ch. 8 and ch. 5.
POSC 459 — Social Welfare Politics and Policy Week 7 · Wednesday, October 7
Grogan and Andrews, “Medicaid” · Howard (2007), ch. 8 and ch. 5
What share of U.S. births does Medicaid pay for?
What share of nursing-home residents?
What share of children?
“stave off claims for broader health-care coverage” (p. 339)
| Seed | What it lets a state do |
|---|---|
| Medical indigency | Cover people who aren’t poor but can’t pay the bill |
| Comprehensive benefits | Pay for nearly any service |
| A generous federal match | Spend a dollar, get 50 to 75 cents back |
Grogan and Andrews, p. 339
Rep. Henry Waxman (D-CA), health subcommittee chair, 1979–1994
| 1984–87 | Options: states may cover more pregnant women and children |
| 1988–90 | Mandates: states must |
| 1990 | All poor children under 18, phased in through 2002 |
“the Waxman wedge” (Howard, p. 103)
| Audience | The pitch |
|---|---|
| Public health | Fewer infant deaths |
| Business | A healthier workforce |
| Abortion opponents | More babies carried to term |
| Insurers | Better than national health insurance |
“an investment, not expense” (Howard, p. 104)
| Before | After | |
|---|---|---|
| Births paid by Medicaid | 17% (1985) | 45% (1991) |
| Children covered | 9 million (1980) | 19 million (2000) |
| Spending | $25 billion (1980) | $200 billion (2000) |
Howard, pp. 95, 98
| Births in Arkansas and Oklahoma (2009) | 64% |
| Nursing-home residents | 70% |
| Children who get Medicaid services | 60% |
| Americans covered | 1 in 5 |
Grogan and Andrews, p. 343
Grogan and Andrews, pp. 344–345
Front stage: block grants, lawsuits
Backstage: take the match
ACA lawsuit, which states joined? Correlation with:
| Governor’s party | Projected cost to the state |
|---|---|
| .8 | .15 |
Grogan and Andrews, pp. 346–347, 350 n. 5
| The chapter | Now | |
|---|---|---|
| ACA expansion | Optional | 40 states and DC in; 10 out |
| Enrollment | 62 million (2009) | 73.2 million (June 2026) |
| Seniors and disabled | 25% of people, 65% of dollars | 23% and 54% |
| Work requirement | None | 80 hours a month, expansion adults, 2027 |
| Eligibility checks | Yearly | Every six months, expansion adults |
KFF, Oct. 2026; CMS, June 2026 snapshot; Pub. L. 119-21 (2025)
Laboratories of democracy, or cryogenic chambers?
Howard 2007, ch. 8
Howard, pp. 154–155, 159
| When | Washington’s choice |
|---|---|
| 1935 | Left it out of the Social Security Act |
| 1956 | Built disability insurance around it |
| 1969–70 | Black Lung; OSHA; a commission |
| 1972 on | Commission says fix it. Congress does nothing |
“it already existed” (p. 167)
Average state score on the commission’s 19 essential elements:
| 1972 | 1975 | 1980 | 1988 | late 1990s |
|---|---|---|---|---|
| 6.9 | 9.4 | 12.1 | 12.2 | 12.8 |
Howard, pp. 173–175
| Howard, ch. 8 | Grogan and Andrews | |
|---|---|---|
| Case | Workers’ comp | Medicaid |
| Federal role | None | Match + mandates |
| States | Frozen | Pushed to expand |
| Who locks it in | Insurers, employers, state boards | Providers, enrollees, governors |
Not expanded (10): AL · FL · GA · KS · MS · SC · TN · TX · WI · WY
Map: kff.org → Status of State Medicaid Expansion Decisions
Use one page from each reading.
8 minutes · then a show of hands
Laboratories or cryogenic chambers?
The smaller side goes first:
name a policy that supports the other side
| Fri 10/9 | Source and claims memo, 11:59 p.m. Attach your conversation |
| Mon 10/12 | Midterm review. Bring questions |
| Wed 10/14 | Midterm, in class, by hand. Bring a blue book |
Medicaid grew because states could draw a federal match.
Workers’ comp froze because nobody in Washington could make states move.
Federalism did both.