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New Roles for Public Health Insurance in Reform. Louis F. Rossiter, Ph.D. Schroeder Center for Healthcare Policy The College of William & Mary Williamsburg, Virginia lfross@wm.edu 757.221.1913. Medicaid’s structural uniqueness. State-Federal Administration Must have low income to qualify - PowerPoint PPT Presentation
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New Roles for Public Health Insurance in Reform
Louis F. Rossiter, Ph.D.
Schroeder Center for Healthcare Policy
The College of William & Mary
Williamsburg, Virginia
lfross@wm.edu
757.221.1913
Medicaid’s structural uniqueness
State-Federal Administration
Must have low income to qualify
Spending increases when economy declines
Dominant payer
Low, administratively established reimbursement rates
Some policy options to decrease overall federal health spending (Antos and Rivlin, 2007)
Improve price setting
Develop information
Improve health care delivery
Promote consumerism and competition
Limit health outlays
Other options
Policy options for Medicaid (Rossiter and Weil, 2007)
Change state incentives
Change how care is delivered
Change the behavior of individual beneficiaries
Reduce program demand
Changing state incentives
Block grant Medicaid?
Per capita caps
“Swap” proposals
Budget caps
Changing how care Is delivered
Capitation
Disease management
Pay for performance (P4P)
Changing individual behavior
Vouchers
Financial Incentives for Health-Promotion Behaviors
Reducing demand for services
Promoting private insurance for long-term care
Premium assistance
National eligibility standards and new federal financing sources
Reimbursement rates
Medicare
Medicaid
State policy changes
Political Economy and Geo-Politics of Comprehensive National Health Care Reform 2009-2012
Big hurdles for comprehensive reform
Presidential election
Fiscal warning signs
Geography Wealth transfer to cover uninsured
South and west face biggest challenges insuring residents
Source: U.S. Census Bureau. “Health Insurance Coverage: 2006.” Figure 9. 2007. http://www.census.gov/hhes/www/hlthins/hlthin06/fig09.pdf
Status of health care reform in the states
Source: The Kaiser Family Foundation. “The Uninsured: A Primer.” October 2007. http://www.kff.org/uninsured/upload/7451-03.pdf
Selected state proposals
California
Massachusetts
Kansas
Minnesota
Oregon
Washington
Federal Proposals in Committee
S. 1169: Feingold -- State-Based Health Care Reform Act
S. 2772: Voinovich-Bingaman --Health Partnership Act
H.R. 560: Baldwin -- Innovation in Health Care through State Initiatives Act
SCHIP legislation
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