The policy and political context of defending Medicaid

Medicaid is often accused of devouring state budgets. In reality, it is a sharp decline in revenue that has precipitated the current state fiscal crisis, not the growth of health care spending. Nonetheless, in a climate of scarce resources, proponents of maintaining health coverage for low-income people through the Medicaid program face a complex challenge that requires them to think simultaneously about policy and building a political constituency for health care for the poor. At the same time, they must challenge the conventional wisdom that argues against raising taxes in times of economic weakness.