The Unfolding Medicaid Story: Congress, Governors, And The Trump Administration

Anyone who has had the chance to witness (or be part of) any of the epic health reform dramas that continually play out in Washington D.C. will agree: in the end, it always comes down to Medicaid. We have once again arrived at one of those moments. The typical starting point for this continuing drama is the initial reaction to Medicaid’s sheer size and reach—16 percent of all health care spending in FY 2014, and 74 million people enrolled as of December 2016. These figures are especially astonishing to the newly initiated when one compares them to where Medicaid was only 37 years ago in 1980—fewer than 20 million people enrolled, expenditures around $25 billion. It is when one begins to consider the causes of Medicaid’s exponential growth that it begins to dawn on the observer just how complicated reforming the program can get. Medicaid size and scope are a reflection of profound drivers: escalating poverty especially among families with children; population demographics and an aging society; the widespread erosion of employer coverage, particularly for lower income workers; infant mortality and child development; major advances in life-saving technology; and public health crises both natural and manmade. Over a half century, federal and state policymakers alike have turned to Medicaid because its flexible structure repeatedly has offered the ability to nimbly respond to social problems as they emerge—for example, ramping up relatively quickly in the f...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Following the ACA Insurance and Coverage Medicaid and CHIP block grants governors per capita caps States Source Type: blogs