The Erosion of Medical Leadership in Public Health

Haughton, James G.
February 2001
Journal of Public Health Policy;2001, Vol. 22 Issue 2, p133
Academic Journal
This article deals with the leadership in public health in the U.S. The Kerr-Mills Act had passed in 1960 and was being implemented across the states, but the law was deeply flawed. While it had created entitlement to health care for a group of citizens, the medically needy aged 65 and over, it had done so in the context of welfare law. The passage of Kerr-Mills did not end the debate concerning dignified access to health care for the elderly because millions of them had refused to be stigmatized as welfare recipients in order to obtain health care. The debate led to the introduction of the King-Anderson bill which would have provided a hospital insurance plan for the elderly. It ultimately culminated in the passage of the legislation creating the Medicare and Medicaid programs in 1965. Medicaid, as a federal grant-in-aid program, requires states to match federal contributions based on a formula linked to state per capita income. Although some people wanted to consider Medicaid as health legislation, the Congress was clear that it was welfare legislation and mandated that it be administered by the single state agency. Those who were in leadership positions in public health agencies pushed hard for an interpretation of the legislation that would at least allow welfare agencies to contract with health agencies to manage the program.


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