The latest effort to amend America’s health care laws may be dead, but the small-government philosophy animating it is very much alive. Senators Graham and Cassidy chose to pursue their health-care reform plan through a block grant, a policy that takes a big chunk of federal money—in this case, Medicaid spending—and hands it over to the states to let them run new programs. Block grants have been created for a number of smaller policies, but the biggest example to date remains the program created under the 1996 bipartisan welfare reform program, called Temporary Assistance for Needy Families. To understand how that effort worked out, I tracked down two policymakers who were intimately involved in the creation of TANF in 1996.
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