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