Drew Altman, Kaiser Family
Foundation Jul 18, 2019
The fact that
“Medicare for All” would eliminate Medicaid hasn’t gotten nearly as much
attention as its elimination of private insurance. But it’s a move that would
largely eliminate states’ role in the health care system.
Why it
matters: State Medicaid programs are leaders in experimenting with
delivery and payment reforms, efforts to control drug costs, and addressing
social causes of ill health, such as poverty and poor housing. All of those
projects would still be important in a single-payer world.
How it
works: Sen. Bernie Sanders’ bill would move most Americans into its new
single-payer system, including people with private insurance but also virtually
all of the 73 million people covered by Medicaid and the Children’s Health
Insurance Program.
Winners: States would
reap huge savings. Medicaid is the single largest item in most state budgets.
- The
effects on safety-net hospitals and clinics would vary, depending largely
on how payment rates under the new plan compare to today’s Medicaid rates.
- The
uninsured in states that have not expanded Medicaid also would be big
winners.
Yes, but: The change
would all but eliminate states’ role in health care, where they have been
leaders not just in providing coverage, but also driving efficiency and testing
new models of care.
- Those
reforms — and the idea of states as laboratories of reform — would pretty
much disappear, and the balance of federalism in health would
fundamentally change.
The bottom
line: For advocates of a single national plan, eliminating the
patchwork of state Medicaid programs would be progress. For fans of a
federal-state balance, it’s a big problem.
- Either
way, Medicaid is a large and generally popular program, and its future at
least deserves a bigger role in the debate.
No comments:
Post a Comment