This Congress has an opportunity to reverse a two-decade trend of federal domination in health programs by approving the President's program to increase the responsibility of state governments for administration of health programs. The Congress is thus faced with a momentous decision: Will it trust the states with such responsibility? Conversely, will the states accept the challenge and assume such responsibility?
For almost two decades, there has been a steadily increasing concentration of control in Washington, DC, of health care programs. Program after program has been added to the federal ambit, building on the foundation programs of Medicare and Medicaid. While there have been minor swings of the pendulum, at times sharing some control with the states, the overall movement to Washington has resulted in the dominance of the federal government as the most significant entity affecting health care provision in the United States today. Its influence and policies do