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IN THE CASE OF FEDERAL FUNDING OF NEIGHBORHOOD HEALTH CENTERS, AN INNOVATIVE MODEL OF HEALTH CARE DELIVERY WAS DEFINED PRIMARILY AS A PROGRAM TO PROVIDE GREATER ACCESS TO HEALTH SERVICES FOR LOW-INCOME PEOPLE. THE ALTERNATIVE POLICY THUS DID NOT THREATEN THE ORGANIZATIONAL ARRANGEMENTS WITHIN THE "MAINSTREAM" HEALTH SYSTEM.

Assuring that low-income children have health coverage would seem to be a noncontroversial and popular issue. Yet, the policy history of US children's health insurance is full of drama, and the fate of the federal State Children's Health Insurance Program (SCHIP) has been marked by ideological conflict and two presidential vetoes. Why? Alice Sardell answers this question through an examination of the policy legacies and decisions that shaped SCHIP, the advocacy strategies that created and sustained it, and the actors who interacted to either support or oppose its expansion. Equally, her analysis illustrates the critical importance of policy entrepreneurs, both inside and outside government, in the US policymaking process

Power relationships in US primary care policy are discussed, focusing on the "mobilization of bias" by dominant interest groups against structural alternatives. The structure of the primary care sector is briefly reviewed, noting the dominance of private enterprise, the separation of individual from population health responsibility, & the primacy of MDs in the decision-making process. The initiation of neighborhood health center projects in the mid-1960s is discussed as a challenge to this structure; while the centers were designed to serve all members of the immediate community, it is demonstrated that bias mobilization established them as access points for lower income people, thus preserving the structure of mainstream health care. Modified Author Conclusion.

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, which was designed to ensure that Medicaid-eligible children receive comprehensive health services, is the only national attempt to provide a right to these services. The political factors that have shaped national EPSDT policy during the past decade are described, based on a conceptual framework developed by John W. Kingdon. The analysis focuses on the roles of two distinct sets of policy entrepreneurs: child health advocates and fiscally conservative governors. Their activities are described in relation to the larger political environment, or "political stream," from the period of the expansion of Medicaid eligibility for pregnant women and children in the late 1980s to the enactment of a new State Children's Health Insurance Program (SCHIP) in 1997. The relative saliency of eligibility and benefit issues in children's health policies had a major influence on the politics and outcomes.