Chapter 15

1. Chapter 15
Health and Welfare

2. Public health
• Federalism and public health
– AFDC
– TANF
– Patient Protection and Affordable Care Act
• Issues in public health

3. Political culture
• Public health across states
• Public opinion and public health

4. Government and healthcare
• History of health and welfare policy
• Differences across parties

5. Healthcare history
• Local government leadership
• Almshouses and hospitals
• 19th century reforms

6. Social safety net
• Historical basis
• The Great Depression
– Social Security
– AFDC

7. Medicare and Medicaid
• Policy priorities
• Expenditures

8. Costs of providing public
health
• Changing economic conditions
• Shift in political culture
• “Welfare queens”

9. Devolution revolution
• Ronald Reagan, Tommy Thompson, and
Bill Clinton
• States and localities as primary actors

10. Welfare reform
• Policy experimentation
• AFDC and TANF

11. Healthcare reform
• Managed care and HMOs
• CHIP
– Number of uninsured children dropped by 20
percent
– Not reaching all children who need it
– Expanded to reach some adults

12. Failure of healthcare reform
• Prescription drugs
• Decline of managed care and HMOs
• Long-term care
• Faltering economies

13. Reform
• Mandated insurance
– Based on income
– Too costly for states
• Patient Protection and Affordable Care Act
• Shift in federalism?

14. Issues to watch
• Health information technology
• Long-term care
• The return of public health
• Local initiatives

15. Conclusion
• Shared responsibility among levels of
government
• Federal healthcare reform
• State and local challenges