Dimensions of federalism in Medicaid reform

Analysis of the various Medicaid proposals in the 104th Congress reveal different notions about the proper balance of power and responsibilities between the federal government and the states. These differences made it difficult to find a compromise, especially because they were unstated. To clarify these differences, this article compares the legislative proposals on two dimensions: (1) the overall structure of the federal-state relationship; and (2) the division of the major categories of functions between different levels of government. This framework can be used to analyze other legislative proposals in order to facilitate compromise.