Win McNamee/Reuters

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.

To access this story, become a member

Sign up for our brand-new membership program, The Masthead, and you’ll not only receive exclusive content you can’t find anywhere else—you’ll also help fund a sustainable future for journalism.

Find Out More

We want to hear what you think about this article. Submit a letter to the editor or write to