Risk-Sharing Schemes : A Case Study

There is a connection between socio-economics and health.79 Therefore, it’s expected when a states decided to expand Medicaid for more low-income residents, and then that population of people tend to be sicker than the rest of the population (Gershon & Sullivan, 2014). These reasons for expanding Medicaid will transfer those individual’s off the exchange policy into Medicaid, especially those within 100%-133% FPL range. Medicaid expansion could cause the exchange risk pools to become healthier, which means a healthier-risk pool that may be a financial boom for insurance companies that have participated in the exchange. Insurers that participate in the exchange are subject under law, to loss of medical ratio’s; which prevents them from retaining more than a certain level of profit (Gershon & Sullivan, 2014). In cost savings, with a healthier- risk pool possibly can be passed down for other consumer’s to use.

There are major challenges faced by policy makers such as trying to control the cost of Medicaid spending because Medicaid is the biggest payer of these services. Policy makers must ensure that they are also keeping the individual served front and foremost in their decisions. Ensuring that quality services are met is one piece of the puzzle. As stated, unfortunately it seems that those who have lesser insurance or who cannot afford these services are provided with less than

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

Medicaid initially established that each state is responsible for designing their medical costs to pay medical care for the poor. Also, Medicaid created as a voluntary program for each state; they have to have the choice to participate. For one thing, because of the rising costs of healthcare, it has been difficult to bring Medicaid recipients into the “mainstream” of United States (U.S.) medical care. Donald R. Barr notes, “between 1975 and 1989, the cost of the Medicaid program increased by an average of 11.9 percent per year before adjusting for inflation” (172). The rising costs of healthcare are necessary for each state to determine if it is beneficial for them to participate in the Medicaid program. As the government level of payment is determined by each state economic condition. For instance, a state with lower per capita income will receive more government funding. A state with higher per capita income receives less reimbursement for program costs. Therefore, on December 31, 2010, many states continued to experience budget cuts. As a result on August 2010, Congress increased reimbursement rates through June 2011.

The costs associated with Medicaid have continued to increase over the years, consuming a larger amount of both federal and state budgets throughout the country. There are now worries about Medicaid eating up state budgets throughout several states. In Kaiser Health News, Rau (2013) reported that "health spending will rise faster than economic growth." With such a significant increase in Medicaid costs, there is the danger of notable shortfalls within the Medicaid spending at the state level. Without adequate reforms, the costs associated with Medicaid threaten to consume a larger portion of state budgets, which could sequentially affect other budget items. An increase in the number of enrollees, growth in provider payments, and an increase in healthcare costs are some of the main reasons for an increase in Medicaid costs. The intricacy of the Medicaid costs problem within the United States is made worse by a decrease in state funds.

With the implementation of the ACA, many states have expanded their Medicaid programs to include a larger population of low income individuals and families that were not able to obtain health insurance prior to the law. Some of the issues that state legislators struggle with are the overall cost of providing services for the additional recipients, staying within budget, determining an adequate approach of offering quality care, and providing adequate coverage for each recipient. Even though the cost of Medicaid expansion within each state has increased the budget for the program, new appraisals has shown that Medicaid programs spend less per enrollee than commercial health insurance and much of the increase in Medicaid expenses originate from the increase in enrollment in the programs (Coughlin, Long, Clemens-Cope, & Resnick, 2013).

The following analysis will explore the current health insurance problem under the ACA. It will discuss the proposed policy of Medicaid Expansion and the impact of States not cooperating with the implementation of such provision. Moreover, a recommendation on strategies to alleviate the health

For instance, there is a difference between universal healthcare plans and actual universal healthcare. One is just the creation of common regulations on the quality of care that patients receive while the other focuses on the technical aspects of the plan as a whole, such as who it should be available to and how much are they to be charged. While other nations have an increased risk of facing obstacles including waiting lists, rationing, and physician choice, the United States is already seeing some of these complications, which results in an overall rise in healthcare costs. Though other nations may spend less than the United States as a whole, the overall rising cost of healthcare is leading to major budget deficits, tax increases, and benefit reductions (Tanner 2008).

As stated in the article “Medicaid Spending: A Brief History”, the Omnibus Budget Reconciliation Act (OBRA-1981) decreased federal contributions in states where growth exceeded certain goals; this was a three-year reduction which cut matching rates by up to 4.5% in 1982, 1983, and 1984. Eligibility changed as well which made it increasingly difficult for families to receive Medicaid coverage. Reductions in federal contributions led to flexibility provisions that “broadened State options for providing and reimbursing Medicaid benefits, as well as State authority to limit coverage under medically needy programs” (Klemm, 2000). This led to experimentation with alternative options such as Health Maintenance Organizations to manage services and costs because most

There are some problems that must be addressed in the expansion of the Medicaid policy to include; social, economic, ethical, legal and political. First, the social impact of having health insurance removes the burden off of parents, people with chronic diseases, children and the disabled. If access to health insurance is unavailable our nation’s health care costs will continue to rise,

The rising cost of health insurance has been an issue that many states have had to struggle with across the country. The state of Minnesota is one of these states in which spiraling health care have increased regardless of cuts to health and human services programs. Budget analyses for the state of Minnesota clearly indicated that new strategies are needed to reduce the growing rate of health care spending.

The challenge between both federal and state authority is how it has been brought up with its federalist structure of American government. Debating over what kind of power should belong to each, most of the power goes to the states under the Constitution to govern daily actions. Since the early 1970s, the federal government has been regulating areas that deal with insurance. However, everything the state does has to be subject to anticipation of the federal government when a lot of concerns start coming into play whether if it about interstate commerce, defense or foreign relations. Fear that states could get overwhelmed with influential lobbying, insurers would seek to weaken consumer protections and raise prices on the insurance. While it has done some good for some over the past few years, Obamacare, or also known as the Affordable Care Act, has helped drop the uninsured rate from 18 to 12.9 percent, allowing more Americans get health insurance However, it is failing to keep the promise of low cost, affordability and care quality. In the long run, Americans will not get the coverage needed to sustain the supposing opportunity of cheap health care. Its flawed political negotiations and trade-offs gives favor to corporate stakeholders in the medical industry over patients and family’s needs for medical support. Having a weak federal oversight of the programs running within the states

In the United States, the health care system differs state by state. Each state has their own set of laws and regulations that fit their standard of morality. When it comes to health care, each state may differ in healthcare’s cost, access and quality. There are also many things that affect these regulation, such as the states sociodemographic and the populations overall health. In the state of Louisiana, there are great differences in their system compared to the overall country’s population.