| Medicaid is a health and long-term care coverage program for those who cannot afford to pay for their medical care because of poverty, old-age, and/or disability. Medicaid is a means-tested entitlement program that is financed jointly by the federal and state governments. Although there is a general framework set by the federal government, states are allowed considerable flexibility in program structure to determine eligibility and service levels. This study seeks to improve our understanding of what and how various factors affect disparities in Medicaid expenditures across the 50 states in fiscal year 2004. Total Medicaid expenditures were tested as a dependent variable in order to obtain the range in the variance of state's characteristics to fund basic health care for low-income individuals. As a first level of data analysis, multivariate analysis of covariances were applied to test the significant effects of state level political characteristics and progressiveness of taxation on Medicaid expenditures, and linear regressions were used to learn more about the relationships of political willingness and health care interest group power with Medicaid expenditures. State financial capacity and demographical influences were controlled in the data analyses. The findings show that (a) political party affiliation, (b) greater Medicaid eligibility, and (c) progressive tax structure in the form of corporate income tax significantly affect levels of Medicaid expenditures. In addition, the effect of regionalism emerged as an unexpected variable that significantly predicted levels of Medicaid expenditures. As a second level of data analysis, path-analysis by structural equation modeling was utilized to show simultaneous relationships among all predictor variables and the dependent variable. This analysis indicated healthcare interest group power and Medicaid need were negatively associated with Medicaid expenditures. Political characteristics, political willingness, progressiveness of taxation, and financial capacity were detected as positive predictors. Political willingness and progressiveness of taxation were revealed as mediating variables. Implications of findings for social policy and professional social work in the 21st Century were discussed, as findings clearly demonstrated the important impact political party affiliation has on health care resource allocation for the most vulnerable members of our society. Implications for future research were discussed. |
