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Innovative Policy Options for Public Health Insurance Reform

Explore Medicaid's unique structure, policy options to decrease federal health spending, and proposals for changing Medicaid incentives, care delivery, and beneficiary behavior. Dive into the political economy and geo-politics of national health care reform, state proposals, and federal legislation.

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Innovative Policy Options for Public Health Insurance 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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