Fiscal Balance In The American Federal System

This book analyzes the states' experience with balanced budget requirements and extrapolates lessons for a federal amendment. The author's focus is not on the wisdom of cutting the federal budget deficit, but rather on the role and effectiveness of these requirements in achieving budgetary balance.

'The ideology of a balanced federal budget has maintained a remarkable hold over American politics. No generation has been free from pitched battles over national debt. In this lively and well-written book, James D. Savage contends that the federal deficit must be understood as a primarily political, not an economic, phenomenon whose symbolism has shaped more than two hundred years of American economic policy.'--Journal of Politics

The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.

The 2021 edition includes input indicators on public finance and employment; process indicators include data on institutions, budgeting practices, human resources management, regulatory governance, public procurement, governance of infrastructure, public sector integrity, open government and digital government. Outcome indicators cover core government results (e.g. trust, political efficacy, inequality reduction) and indicators on access, responsiveness, quality and satisfaction for the education, health and justice sectors.