Health Policy Commons^™

The Power To Block The Affordable Care Act: What Are The Limits?, John D. Kraemer, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Though Supreme Court upheld most parts of the Affordable Care Act (ACA), Congress’ goals in enacting it could still be frustrated by non-implementation. During his campaign for president, Governor Romney promised “to issue Obamacare waivers to all fifty states.” While such blanket waivers would likely violate the Constitution’s Take Care Clause, the ACA does permit other waivers. To be lawful, however, they must meet certain requirements designed to enhance access and lower cost. A president who opposes the ACA might be able to limit its implementation by refusing to issue premium subsidies in federally operated insurance exchanges, and this might …

Medicaid Coverage For Individuals In Jail Pending Disposition: Opportunities For Improved Health And Health Care At Lower Costs, Marsha Regenstein, Jade Christie-Maples

Health Policy and Management Faculty Publications

The Patient Protection and Affordable Care Act (ACA) provides an unprecedented opportunity for millions of poor men and women to obtain insurance coverage to address their substantial acute, chronic, physical and behavioral health care needs. The ACA raises Medicaid eligibility levels to 133 percent of poverty, thereby enabling adults with or without children to qualify for coverage. A substantial percentage of the newly eligible population will be jail-involved individuals – people who have had interactions with the legal system over the course of a year, including as an inmate at a county or city jail. Many of these individuals are …

Increasing Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. States design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control. The incorporation of multiple, sometimes conflicting incentives into state reimbursement systems has resulted in enormously complex and demanding methodologies that inhibit consumer participation in state rating setting decisions. In turn, the lack of consumer involvement has the potential to result in the adoption of reimbursement systems that favor industry and government interests at the expense of issues important …

Affordable Care Act Litigation: The Supreme Court And The Future Of Health Care Reform, Lawrence O. Gostin, Kelli K. Garcia

Georgetown Law Faculty Publications and Other Works

In Florida v. HHS, a lawsuit brought on behalf of 26 states challenging the constitutionality of the Patient Protection and Affordable Care Act (ACA), the Supreme Court will determine the future direction of health care reform in the United States. During the unprecedented 5-1/2 hours of oral arguments, the Court will hear 4 issues: the individual purchase mandate, severability, the Medicaid expansion and the Anti-Injunction Act.

The states challenging the ACA maintain that the purchase mandate uniquely penalizes individuals for failing to purchase insurance. Uninsured individuals, however, rarely do nothing. Instead, they self-insure, rely on family, and cost-shift to …

A Primer For Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. To ensure that providers behave appropriately, the federal and state governments have established an extensive set of regulations that nursing homes must comply with if they are to be reimbursed for patients insured by Medicaid. Consumers exert considerable influence here by focusing on regulations and enforcement of non-compliance.

States also seek to align providers’ interests with those of other interested parties through controls and incentives built into state reimbursement systems, including with respect to facility cost and quality, access to care, payment equity, service capacity, and budgetary …

Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota For State Policymakers, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. State governments design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control.

Often, participation in the process of developing Medicaid payment policy is limited to state agency officials and providers of care and, occasionally, union representatives and state legislative staff. Invited less frequently to reimbursement policy discussions are consumer representatives. Lack of consumer involvement in the development of state rate setting systems has the potential to result in the …

Projecting The Impact Of The Money Follows The Person Program On Idaho Medicaid Long-Term Care Expenditures, Andrew Michael Hyer

Boise State University Theses and Dissertations

Background: It is well established that access to home and community-based services (HCBS) as an alternative to institutional long-term care (LTC) leads to better health outcomes. Because Medicaid is the primary payer for formal LTC services, changes in Medicaid policies favoring access to HCBS play a crucial role in “rebalancing” the nation's LTC delivery system. Prior research indicates that expanding Medicaid HCBS may result in lower per patient expenditures. A key part of Medicaid's rebalancing effort is the recently expanded Money Follows the Person (MFP) program, whereby the federal government offers enhanced match funds to assist state Medicaid programs in …

The Way It Was In Health Policy, And Probably Will Be: Learning Lessons By Rashi Fein (Book Review), Rick Mayes

Political Science Faculty Publications

Learning Lessons by Rashi Fein is an enjoyable memoir from a scholar and policy adviser unlike any other. Fein’s influential involvement in health care policy dates back to John F. Kennedy’s administration, and his career as a leading health economist paralleled the significant growth in the political influence of health economists following the enactment of Medicare and Medicaid in 1965. Now an emeritus professor of the economics of medicine at Harvard Medical School, Fein writes here about the lessons he learned in medicine, economics, and public policy. His view of the policy process, as a way of coming to …

Community's Safety Net: A Comparative Analysis Of The Role Of Nonprofit Hospitals In Barrow And Clayton Counties In Providing Services To Its Medicaid Population, Carlene Coggins, Julie John

Dissertations, Theses and Capstone Projects (Full IR Collection)

Nonprofit hospitals serve as part of the healthcare safety net to deliver a significant level of care to low-income, uninsured, underinsured, Medicaid and other vulnerable groups in society. Safety net hospitals are defined as those hospitals where at least 10 percent of the costs of care provided is uncompensated. Nonprofit hospitals are granted tax exemptions from the government and in exchange they are required to meet community benefit standards which include offering care to a relatively large proportion of uninsured or socially disadvantaged individuals.

Increasing poverty levels due to rising unemployment, foreclosures and economic distress have placed the safety net …

The Role Of Medicaid In Promoting Access To High-Quality, High-Value Maternity Care, Anne R. Markus, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The main purpose of this article is to analyze and describe the role of Medicaid in facilitating access to care for pregnant women and ensuring high-quality maternity care that is affordable. It first summarizes the federal Medicaid requirements regarding eligibility, coverage of benefits, financing, and service delivery, with a special emphasis on existing quality provisions. Then, it discusses current issues and recommends several Medicaid reforms, particularly in the area of quality assessment and improvement. All reforms, including Medicaid reforms, should seek to support the IOM-identified aims. Much of the emphais in Medicaid policy development has been focused on access to …

Increasing Access To Prenatal Care: The Impact Of Access Barriers And Proposed Strategies To Overcome Them, Courtney Thomas

XULAneXUS

For a country with such a technologically advanced health care system, the United States has an alarming infant mortality rate. The disparities in birth outcomes for low-income black women compared to white women of the same socioeconomic status are even more disturbing. Prenatal care is considered to be an effective method of reducing poor birth outcomes like preterm birth and low birth weight, but access to prenatal care continues to be an issue. There are several known barriers to care, including demographic, financial, structural, and personal barriers, that pregnant women must overcome to receive adequate prenatal care. With increased access …

Nevada Medicaid And Check Up Programs: Barriers To Enrollment And Utilization, The Nevada Institute For Children’S Research And Policy, Denise Tanata Ashby, Jennifer Waddoups, Tara Phebus

Nevada Institute for Children's Research and Policy Reports

This study offers only a brief look at some of the barriers Nevada children and families face with Medicaid and Nevada Check Up. Strengthening the Medicaid and Nevada Check Up programs is vital to improving children’s health care access and utilization in Nevada. By developing and implementing legislation to improve public health insurance coverage, access, and utilization in Nevada, policymakers can ensure a brighter, happier, and healthier future for Nevada’s children and families.

A Trade-Off Proposal For Funding Long-Term Care, Yung-Ping Chen

Gerontology Institute Publications

Long-term care can be a depressing subject. Most of us tend not to think about it. However, we cannot long avoid it as the 76 million baby boomers begin reaching older ages in a few short years. According to projections, in 40 years, those aged 65 to 84 (numbering 31.6 million in 2005) will more than double, and those 85 plus (about 5.1 million in 2005), who are more at risk of dependency, will more than triple (U.S. Census Bureau, 2004 and 2006). Heavy reliance on Medicaid, already the second largest budget item in most states, would not appear viable. …

Berbagai Faktor Yang Berhubungan Dengan Beban Biaya Obat Pasien Rawat Inap Program Askeskin, Di Cirebon Tahun 2005, Lucya Agung Susilawati, Hasbullah Thabrany

Kesmas

Askeskin membayar klaim pengobatan rumah sakit untuk penduduk miskin dengan tarif yang ditetapkan. Namun, resep obat tidak terdaftar yang tidak boleh dibebankan pada pasien justru menjadi beban rumah sakit. Inisiatif pimpinan RSUD Gunung Jati menyediakan dana pendamping menjadi beban secara finansial. Pada tahun 2005, rujukan pasien rawat inap kelas III, meningkat 153% dan beban pasien luar kota meningkat 331%. Tujuan penelitian ini mengetahui faktor faktor yang mempengaruhi beban RS menutupi biaya perawatan, khususnya obat non DPHO yang tidak dapat diklaim ke Askes. Penelitian menggunakan sumber data catatan medik, catatan klaim dan studi kualitatif wawancara mendalam. Ditemukan bahwa pasien luar yang …

Medicaid And Health Information: Current And Emerging Legal Issues, Sara J. Rosenbaum, Patricia Mactaggart, Phyllis Borzi

Health Policy and Management Faculty Publications

Legal questions are an inevitable byproduct of significant technology change in health care such as that underway as a result of health information technology (HIT). This article examines several important existing and emerging legal questions in a Medicaid context. First, do the Centers for Medicare & Medicaid Services (CMS) and State Medicaid agencies, have a fiduciary obligation to adopt and fully use health information technology given its potential to improve health care quality while reducing racial, ethnic, and socioeconomic disparities in health and health care? Second, how can Medicaid privacy standards be reconciled with the Health Insurance Portability and Accountability …

Variations Among Regions And Hospitals In Managing Chronic Illness: How Much Care Is Enough?, John E. Wennberg

Center for Policy Research

Classic epidemiology looks at what happens to people who live in a defined region over time. For example, birth rate, the number of births that occur among populations over a year, is a common statistics that we're all familiar with. Since the early 1990s we have conducted research at Dartmouth Medical School to convert that classic epidemiologic perspective into looking at what is happening in terms of the health care system itself. We ask how much care people are getting in different regions of the country. We want to know the patterns of that care. And we want to get …

Changing Economic Incentives In Long-Term Care, R. Tamara Konetzka

Center for Policy Research

Just as managed care has changed utilization and incentives in other parts of health care, there is a whole set of incentives built around long-term care that really matter. For example, if nursing homes have a financial incentive to hospitalize people with certain health conditions, then in the long run they are not going to develop the programs and invest in the resources to treat those people in the facility. Instead they're going to use those resources to stay in business or to provide other types of care. And while we can assume that policymakers do not create regulations that …

The Benefits Improvement And Protection Act (Bipa) And Its Impact On The Stability Of Provider Networks In Medicare + Choice Managed Care Organizations (Mcos), Frances R. Nelson

UNLV Theses, Dissertations, Professional Papers, and Capstones

No abstract provided.

California’S In-Home Supportive Services Program: Who Is Served?, Debi Waterstone, Taewoon Kang, Cristina Flores, Candace Howes, Charlene Harrington, Robert Newcomer

Economics Faculty Publications

Governor Schwarzenegger's preliminary 2004-05 Budget Bill proposed to eliminate a component of California's In-Home Supportive Services (IHSS) program serving approximately 68,000 individuals. This component, known as the Residual Program, included Protective Supervision and Domestic Care services and services provided by parents and spouses. Under the then existing regulations and the state's approved state plan for Medicaid, these services did not qualify for shared financing with the Medicaid program and were thus funded solely by state and county sources. The objective of the administration's proposal was to obtain an estimated net savings from the IHSS program in Fiscal Year 2005 of …

Universal Coverage And The American Health Care System Crisis (Again), Rick Mayes

Political Science Faculty Publications

Ten years after President Clinton’s ambitious attempt at comprehensive health care reform died, several old and new issues with the health care system have emerged. First, the number of uninsured Americans rose to 43.6 million in 2002—and the numbers have since increased. Also, the costs for those who do not have insurance are rapidly increasing. In addition health care related problems are one of the leading causes of personal bankruptcy in the United States. Finally, the government’s two primary health insurance programs—Medicare and Medicaid—are experiencing considerable financial strain. Dr. Mayes examines these problems in depth before and revisits President Clinton’s …

Medicaid, Managed Care, And Kids. 12th Annual Herbert Lourie Memorial Lecture On Health Policy, Deborah A. Freund

Center for Policy Research

This policy brief talks about what managed care for Medicaid is, how it influences kids, and how it relates to the State Child Health Insurance Program (CHIP). It focuses on what we have learned over the last 20 years through research about cost, use, and quality. It also discusses some of the expectations we had for children covered by Medicaid managed care. Finally, it talks about the future of Medicaid managed care and the implications for CHIP.

New Conundrums: Public Policy And The Emerging Health Care Marketplace, James R. Tallon

Center for Policy Research

There is a fundamentally new dynamic in American health care, one that has yet to be fully experienced but that threatens to leave a large portion of the American population without access to the quality health care they have received in the past. While the federal government has not completely abandoned the goal of assuring universal health care, a goal that dates back to the creation of Medicare and Medicaid in the 1960s and even earlier, the mechanisms to pursue that goal have changed. The implicit contract between government and health care providers--mostly doctors and not-for-profit hospitals--under which subsidized care …

Flyer: “Safeguarding And Strengthening Medicare And Medicaid.” President Bill Clinton. Clinton/Gore. August 21, 1996., Clinton/Gore '96 Primary Committee, Inc.

Saffy Collection - All Textual Materials

A Flyer promising that Clinton will maintain and extend Medicare and Medicaid support.

Flyer: “Protecting Our Seniors.” President Bill Clinton. Clinton/Gore. August 21, 1996., Clinton/Gore '96 Primary Committee, Inc

Saffy Collection - All Textual Materials

A Flyer detailing Clinton's policies on protecting Medicare and Medicaid, quality health care, and other issues related to senior citizens' concerns.

Trends In Hospital And Nursing Home Care Expenditures, Maine, 1982 To 1986, Maine Department Of Human Services

Maine Collection

Trends in Hospital and Nursing Home Care Expenditures, Maine, 1982 to 1986

Maine Department of Human Services - Office of Data, Research, and Vital Statistics

John R. McKernan, Jr., Governor, Rollin Ives, Commissioner, Brenda Smith, Planning and Research Associate, May, 1989.

"This report produced under Appropriation No. 1310-4010."

Contents: Introduction / Hospital Care Expenditures / Nursing Home Care Expenditures / Comparison of Hospital and Nursing Home Care Expenditure Trends / Concluding Remarks / References

Medicaid And Medicaid Cost Containment In Massachusetts, Fredric A. Waldstein

New England Journal of Public Policy

The purpose of this article is to describe Medicaid's financial structure and examine cost containment efforts to limit future growth of the program, particularly pertaining to Massachusetts. The principal focus is the Massachusetts Department of Public Welfare and the Massachusetts Medicaid Fraud Control Unit, the two agencies most responsible for Medicaid cost containment in the commonwealth. Because elected officials are unwilling to face directly the troublesome issues surrounding Medicaid and its growth, the government agencies responsible for cost containment have been left to define the scope of the problem, design remedial strategies, and evaluate their success. This process is found …