Health Affairs

Medicaid Reform

Bethesda, MD -- Medicaid, the nation's largest public health insurance program, provides health coverage for low-income people, or about one in five Americans. The program will also play a central role in expanding insurance coverage under the Affordable Care Act. However, recent concerns about federal budget deficits and the fiscal pressures on states have generated new proposals to alter Medicaid. This latest health policy brief from Health Affairs and the Robert Wood Johnson Foundation explores some of the major ideas being discussed for remaking the program.

The brief covers the following:

• Proposals for Change: The brief outlines some key reforms being discussed, which fall into two basic categories: those would end the program as an "open-ended" entitlement and give more control to the states, and those that would preserve the entitlement but make changes to achieve savings. Converting the program into a system of federal block grants to states is a long-standing idea that has recently gained new traction with some Republican governors and members of Congress. Opponents of this idea fear that such a dramatic change in the program would cause serious damage to the social safety net. The Obama administration supports preserving Medicaid as an entitlement program but has proposed several measures that would create significant savings and reduce fraud and abuse.
  
  

• What's Next: The debate over federal and state roles in administering Medicaid could be redefined by several cases now before the Supreme Court, which focus on states' authority to cut Medicaid payments to certain providers as well as the constitutionality of the Medicaid coverage provisions of the Affordable Care Act. Medicaid's future is also likely to be affected by the outcome of the 2012 presidential and congressional elections, as well as by the course of the US economy.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at www.healthaffairs.org. You can also find the journal on Facebook and Twitter and download Narrative Matters on iTunes. Address inquiries to Sue Ducat at (301) 841-9962 or sducat@projecthope.org