Medicaid and the Costs of Federalism, 1984-1992 by Jean Donovan Gilman

Author:Jean Donovan Gilman [Gilman, Jean Donovan]
Language: eng
Format: epub
Tags: Social Science, Sociology, General
ISBN: 9781317733249
Google: KEjWDwAAQBAJ
Publisher: Routledge
Published: 2020-03-11T05:00:39+00:00

This more open process of debate, along with the Senate’s traditional role of considering the President’s requests5 (Davidson 1989, 297), and the more fiscally conservative nature of Senators of both parties, meant that the Senate in the 1980s was less inclined than the House to support expansions in social welfare program, such as medicaid.

Increased Importance of Conference Negotiations

Given how far apart the House and Senate were on the issue of medicaid enlargements, reconciliation was an important mechanism for ensuring that it reached the conference. This process assures that authorization bills will be included in conference even if they are opposed by the other chamber (Davidson 1992, 263). When Congress considers an omnibus measure, if one chamber rejects the bill, it does not die. If one chamber rejects part of the bill, it will still be considered in conference. This feature of omnibus bills minimizes the need for advocates to win broad support in both chambers and enhances the significance of conference negotiations.

Important differences emerged between the House and the Senate positions on medicaid increases. Part of the explanation resides in the different institutional roles of the two chambers as discussed above. Another reason is partisan politics. Republicans controlled the Senate for the first three years of this study, and enlargement of social programs was not one of their priorities. Even when the Democrats controlled the Senate in the late 1980s, they were ideologically split with more fiscally conservative members than in the House. These Senators were less likely to support an increase in medicaid or support it as fully under intense fiscal pressures. Consequently, the Senate was less consistent and less generous in its proposals to expand the medicaid program between the years 1984 and 1990. (SeeTable 6.1 for a summary of those differences.)

The size of conference negotiations also worked to the advantage of medicaid. Because of the size and complexity of the reconciliation bills during the 1980s, the conference committees considering them were also unusually large. Conference committees were broken into subconferences so as to expedite the work. Decisionmaking was structured in such a way that only the few conferees within a particular subconference would vote upon that portion of the omnibus measure. This feature of the conference committee limited the opportunity for opposition and allowed negotiators in subconference to exert great influence over the final shape of the legislation. After conferees signed off on their subconference agreement, each chamber received only one opportunity to vote up or down on the entire package.

Table 6.1 Senate Position on Budget Reconciliation

Budget for Fiscal Year Senate Position on Medicaid Expansions at Time of Conference Committee

1985 Less generous expansion than House

1986 Sought cuts, no expansions

1987 Strong bipartisan support for expansions

1988 Strong bipartisan opposition to expansions after Stock Market crash

1989 Not included in budget legislation

1990 No true expansion beyond inflation

1991 Less generous expansion than House

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