The Irreplaceable Program in an Era of Uncertainty

Abstract

In 2017, Medicaid faced a near-death experience, the third of its 53-year history. Its survival and resilience is a testament not just to its size but to the multiple, vital roles Medicaid plays in the health care system, and its ability to adapt to emerging population health needs. It can take an existential threat to make these indispensable qualities clear.

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References

United States Department of Health and Human Services, 2016 Actuarial Report on the Financial Outlook for Medicaid, Table 3 (2016), available at <https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/MedicaidReport2016.pdf> (last visited October 24, 2018).

Smith and

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Id., at 181-224; see also,

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The Chief Justice may have been wrong on the law when, in National Federation of Independent Businesses v. Sebelius, 132 S. Ct. 2566 (2012) he declared the ACA insurance reforms a “new program” in his analysis of the constitutionality of the Medicaid expansion. But he certainly was correct as a matter of policy in recognizing the ACA Medicaid expansion as a “shift in kind, not merely degree,” an amendment that transformed a “program to care for the neediest among us” into an “element of a comprehensive national plan to provide universal health insurance coverage.” See 132 S. Ct. 2566, at 2605-2606.

10.

The Medicaid managed care market is vast, but it is a market in which plans are structured to share risk with states, not absorb it entirely, and many of the costliest services get carved out of plan contracts. This helps explain the enthusiasm.

11.

Rosenbaum

, Medicaid at Fifty (New York: Oxford University Press, 2018).

12.

This of course helps explain the great tension between the federal and state governments where Medicaid policy is concerned, since as a general matter state operating budgets are expected to adhere to some level of budget-balancing requirement, although the strength of these requirements varies considerably. See National Conference of State Legislatures, State Balanced Budget Provisions (2010) available at <http://www.ncsl.org/documents/fiscal/StateBalancedBudgetProvisions2010.pdf> (last visited October 26, 2018).

13.

Medicaid and CHIP Payment and Access Commission (MACPAC), Medicaid and the Opioid Crisis (July 2017), available at <https://www.macpac.gov/wp-content/uploads/2017/06/Medicaid-and-the-Opioid-Epidemic.pdf> (last visited October 26, 2018).

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15.

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16.

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Wise , “Crossing the Medicaid/Private Insurance Divide: The Case of EPSDT,” Health Affairs 382, no. 26 (2007): 383-384.

17.

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18.

A. Rossier

Markus

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19.

Rosenbaum, supra note 11.

20.

Rosenbaum

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21.

Medicaid and CHIP Payment and Access Commission, Disproportionate Share Hospital Payments, available at <https://www.macpac.gov/subtopic/disproportionate-share-hospital-payments/> (last visited October 26, 2018).

22.

Rudowitz and

Garfield , 10 Things to Know about Medicaid: Setting the Facts Straight (Kaiser Family Foundation, 2018) available at <https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/> (last visited October 26, 2018).

23.

Rosenbaum ,

Schmucker ,

Rothenberg , and

Gunsalus , What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid? (New York: Commonwealth Fund, 2016) available at <http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2016/nov/1913_rosen-baum_medicaid_block_grants.pdf> (last visited October 26, 2018).

24.

Katch

, Medicaid Works: Millions Benefit from Medicaid’s Effective, Efficient Coverage (Center on Budget and Policy Priorities, 2017) available at <https://www.cbpp.org/research/health/medicaid-works-millions-benefit-from-medicaidseffective-efficient-coverage> (last visited October 26, 2018).

25.

See American Health Care Act.

26.

Actuarial Report, supra note 2.

27.

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28.

Coughlin

et al ., What Difference Does Medicaid Make? Assessing Cost-Effectiveness, Access and Financial Protection under Medicaid for Low-Income Adults (Kaiser Family Foundation, May 2013), available at <http://kff.org/medicaid/issue-brief/what-difference-does-medicaid-make-assessing-cost-effectiveness-access-and-financial-protection-under-medicaid-for-low-income-adults/> (last visited October 26, 2018).

29.

Gates ,

Rudowitz , and

Guyer , An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers (Kaiser Family Foundation, September 2014) available at <https://www.kff.org/medicaid/issue-brief/an-overview-of-delivery-system-reform-incentive-payment-waivers/> (last visited October 26, 2018).

30.

See, e.g., Medicaid CHIP Payment and Access Commission (MACPAC), Policy Options for Controlling Medicaid Spending on Prescription Drugs (2017) available at <https://www.macpac.gov/wp-content/uploads/2017/09/Policy-Options-for-Controlling-Medicaid-Spending-on-Prescription-Drugs.pdf> (last visited October 26, 2018).

31.

See U.S. Dept. of H.H.S., Centers for Medicare & Medicaid Services, State Medicaid Directors Letter (Opportunities to Promote Work and Community Engagement Among Medicaid Beneficiaries) (SMD 18-0002) (Jan. 11, 2018); compare Jane Perkins, NHeLP Letter to CMS Regarding Work Requirements, available at <http://www.healthlaw.org/publications/browse-all-publications/nhelp-letter-to-cms-regarding-work-requirements#.Wst9X4jwaUk> (last visited October 26, 2018).

32.

Stewart v. Azar 2018 WL 3203384 (D.D.C. June 29, 2018).