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New Roles for Public Health Insurance in Reform

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

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New Roles for Public Health Insurance in Reform

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  1. 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

  2. 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

  3. 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

  4. 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

  5. Changing state incentives • Block grant Medicaid? • Per capita caps • “Swap” proposals • Budget caps

  6. Changing how care Is delivered • Capitation • Disease management • Pay for performance (P4P)

  7. Changing individual behavior • Vouchers • Financial Incentives for Health-Promotion Behaviors

  8. Reducing demand for services • Promoting private insurance for long-term care • Premium assistance • National eligibility standards and new federal financing sources

  9. Reimbursement rates • Medicare • Medicaid • State policy changes

  10. Political Economy and Geo-Politics of Comprehensive National Health Care Reform 2009-2012

  11. Big hurdles for comprehensive reform • Presidential election • Fiscal warning signs • Geography • Wealth transfer to cover uninsured

  12. 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

  13. 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

  14. Selected state proposals • California • Massachusetts • Kansas • Minnesota • Oregon • Washington

  15. 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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