Can The Trajectory Be Altered?
There are indications that the trajectory of unequal access and care can be altered. Most states indicate that their revenue pictures are finally improving, which has enabled them to consider restoring some of their recent budget cuts. In Massachusetts, the economic upturn, coupled with an urgent need to reconfigure Medicaid and safety-net care funding, has stimulated a vibrant debate about universal coverage for state residents.13 In California, the dismal state of services for the chronically mentally ill, who constitute much of the state’s homeless population, triggered sufficient community concern that a targeted tax proposition was passed to generate an estimated $600 million in new revenues each year to support service innovation.14 And in northern New Jersey, a market that exhibits many trends that threaten to worsen disparities in access and quality, the state is increasing its uncompensated care fund, most recently with a series of controversial tax assessments including a 3.5
