Recent amendments to the Medicaid program: political implications.

Medicaid has never been a popular program. It has from its inception been an expensive social commitment, demanding larger, although not always proportionately larger, shares of the state and federal budgets for nearly two decades. It has been saddled with a welfare-designed structure, thereby ensuring inherent inequities in the distribution of benefits. It lacks the support of an enfranchised constituency; indeed, in pragmatic terms, the only true Medicaid constituency is made up of the state governments which distribute Medicaid funds and the medical care providers who receive them-support which is largely for the purpose of securing the flow of those funds, not for the achievement of Medicaid's programmatic goals