When the Government's Policy Is to Pass the Buck

An interesting little tiff has erupted over the Republican health-care bill wending its way through the House. Most of the politicking over this bill has involved pushing and pulling from various national interest groups. But one debate lighting up my home state is an old-fashioned brawl between levels of government. The tiff is all the more interesting because it shows how policy will be made as America struggles with a needy, aging population.

At issue is the unusual way New York State finances Medicaid. When Medicaid was passed in the 1960s, New York thought it sounded like a splendid idea, and wanted to extend the boon of Medicaid to as many people as possible. The law ultimately signed by Governor Nelson Rockefeller set income eligibility at $6,000 per year for a family of four -- just slightly below the U.S. median family income in that era. This would, of course, be quite expensive, so the law also required that local governments pick up roughly half the tab.