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| Author | : January Angeles |
| Publisher | : |
| Total Pages | : 11 |
| Release | : 2010 |
| Genre | : |
| ISBN | : |
| Author | : Jonathan Gruber |
| Publisher | : |
| Total Pages | : 36 |
| Release | : 2020 |
| Genre | : Medicaid |
| ISBN | : |
Medicaid’s federal-state matching system of financing is the nation’s largest example of fiscal federalism. Using generous federal subsidies, the Affordable Care Act incentivized states to expand Medicaid, which became a state option in the aftermath of a 2012 Supreme Court ruling. As of early 2020, 14 states had not yet expanded, with concerns over state budgetary effects described as a key barrier. We use an event-study approach to analyze state budget data from 2010-2018 and assess the effects of state Medicaid expansion decisions. We find that Medicaid expansion increased total spending in expansion states by 6% to 9%, compared to non-expansion states. By source of funds, federal spending via the states increased by 10% in the first year of Medicaid expansion, rising to 27% in 2018. Changes in spending from state funding were modest and non-significant, with less than a 1% change from baseline annually in the most recent years, 2017 and 2018. Meanwhile, we find no evidence that increased Medicaid spending from expansion produced any reductions in spending on education, corrections, transportation, or public assistance. Changes in Medicaid spending tracked closely with the baseline pre-ACA (2013) uninsured rate in each states, with expansion leading to roughly $2680 in added annual spending per uninsured adult. As a result, we estimate states that didn’t expand Medicaid passed up $43 billion in federally-subsidized program funds in 2018. Finally, state projections in the aggregate were reasonably accurate, with expansion states projecting average Medicaid spending from 2014-2018 within 2 percent of the actual amounts, and in fact overestimating Medicaid spending in most years.
| Author | : William Scanlon |
| Publisher | : |
| Total Pages | : 20 |
| Release | : 1996 |
| Genre | : Managed care plans (Medical care) |
| ISBN | : |
| Author | : Stan Dorn |
| Publisher | : |
| Total Pages | : 7 |
| Release | : 2010 |
| Genre | : |
| ISBN | : |
... this report assesses how state budgets will fare as a result of the Affordable Care Act. The report's findings shed new light on potential savings for state Medicaid budgets which, even in a worse-case scenario, would outweigh costs associated with the health reform law. The analysis shows that savings could range between $40.6 billion to as high as $131.6 billion during 2014-2019.
| Author | : United States. Government Accountability Office |
| Publisher | : |
| Total Pages | : 38 |
| Release | : 2012 |
| Genre | : Medicaid |
| ISBN | : |
The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, made significant changes to the way eligibility for the Medicaid program will be determined and who the program will cover. Under PPACA, eligibility for Medicaid--a joint federal-state program that finances health care for certain categories of low-income individuals--must be expanded to non-elderly individuals with incomes at or below 133 percent of the federal poverty level (FPL) beginning on January 1, 2014. Through this expansion, states will provide Medicaid coverage to eligible low-income parents and childless adults. PPACA also requires the establishment of American Health Benefit Exchanges (referred to as exchanges)--marketplaces where eligible individuals can purchase private health insurance in each state. The Centers for Medicare & Medicaid Services' (CMS) Office of the Actuary has estimated that, as a result of the expansion, the number of Medicaid enrollees will increase by 14.9 million in 2014 and by 25.9 million in 2020. State governments will play a key role in implementing many aspects of this reform, which must be in place by the beginning of 2014. Specifically, states will need to make major changes to the way they conduct Medicaid eligibility determinations for individuals and families. States also will need to develop streamlined eligibility and enrollment systems that allow for the coordination of enrollment across Medicaid, the Children's Health Insurance Program (CHIP), and exchanges. At the same time, states will need to address the financial implications of implementing this Medicaid expansion and accompanying enrollment systems. The federal government will initially provide states with full funding to cover the cost of adults who are newly eligible for Medicaid due to the expansion. Congress asked us to report on the actions states are taking to implement the Medicaid expansion. This report addresses the following questions: 1. What are states' responsibilities for implementing the Medicaid expansion provisions under PPACA? 2. What actions have selected states taken to prepare for the Medicaid expansion provisions of PPACA and what challenges have they encountered? 3. What are states' views on the fiscal implications of the Medicaid expansion on state budget planning?
| Author | : Jagadeesh Gokhale |
| Publisher | : |
| Total Pages | : 36 |
| Release | : 2011 |
| Genre | : Medicaid |
| ISBN | : |
This study estimates and compares potential increases in Medicaid expenditures from PPACA by the five most populous states: California, Florida, Illinois, New York, and Texas. State Medicaid spending is projected to increase considerably even without PPACA in California, Florida, and Texas, with smaller increases in Illinois and New York. With PPACA, projected spending is actually reduced for California, while spending increases are positive and large for Florida and Texas. Both Illinois and New York have the potential for considerably higher enrollments and increased expenditures.
| Author | : Paul Starr |
| Publisher | : Yale University Press |
| Total Pages | : 452 |
| Release | : 2013-06-04 |
| Genre | : Political Science |
| ISBN | : 0300206666 |
In no other country has health care served as such a volatile flashpoint of ideological conflict. America has endured a century of rancorous debate on health insurance, and despite the passage of legislation in 2010, the battle is not yet over. This book is a history of how and why the United States became so stubbornly different in health care, presented by an expert with unsurpassed knowledge of the issues. Tracing health-care reform from its beginnings to its current uncertain prospects, Paul Starr argues that the United States ensnared itself in a trap through policies that satisfied enough of the public and so enriched the health-care industry as to make the system difficult to change. He reveals the inside story of the rise and fall of the Clinton health plan in the early 1990sùand of the Gingrich counterrevolution that followed. And he explains the curious tale of how Mitt RomneyÆs reforms in Massachusetts became a model for Democrats and then follows both the passage of those reforms under Obama and the explosive reaction they elicited from conservatives. Writing concisely and with an even hand, the author offers exactly what is needed as the debate continuesùa penetrating account of how health care became such treacherous terrain in American politics.
| Author | : Alan Weil |
| Publisher | : The Urban Insitute |
| Total Pages | : 448 |
| Release | : 2003 |
| Genre | : Business & Economics |
| ISBN | : 9780877667162 |
The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.
| Author | : Robert D. Ebel |
| Publisher | : Oxford University Press |
| Total Pages | : 1057 |
| Release | : 2012-03-21 |
| Genre | : Business & Economics |
| ISBN | : 0199938318 |
State and local government fiscal systems have increasingly become vulnerable to economic changes. Over the past three decades, state and local deficits during economic recession have been larger and deeper each time. The impact of the Great Recession and its aftermath of feeble growth and lingering high unemployment has been dramatic both in scope and intensity. Before the crisis, long-term structural deficits were persistent for both individual governments and the entire sector as spending plans and patterns outpaced governments' revenue-generating capacity. The revenue systems of these governments eroded while the workloads and scope on the expenditure side of the state and local system budget continued to grow. This handbook evaluates the persistent problems in the fiscal systems of state and local governments and what can be done to solve them. It contains 35 chapters authored by 60 practitioners and academics who are renowned scholars in state and local finance. Each chapter provides a description of the discipline area, examines major developments in policy, practices and research, and opines on future prospects. The chapters are divided into four sections. Section I is a systematic discussion of the institutional, economic, and political framework that provides a background for understanding the structure and financial performance of the state and local sector. The chapters in Section II provide an overview of the various components of state and local revenue systems and how they reacted to the Great Recession. They analyze the diverse forms of taxes and charges in detail, prescribe remedies and alternatives, and examine the implications for future revenue performance. Chapters in Section III turn to spending, borrowing and financial management in the state and local sector. The focus is on the big six service delivery sectors: education, health care, human services, transportation, pensions, and housing. Section IV is a set of chapters that look ahead and speculate about how the state and local government sector's money-raising, spending, and service delivery structures will adjust to the new circumstances.
| Author | : Carter C. Price |
| Publisher | : |
| Total Pages | : 30 |
| Release | : 2013 |
| Genre | : Federal government |
| ISBN | : 9780833081223 |
The Affordable Care Act is a substantial reform of the U.S. health care insurance system. Using the RAND COMPARE model, researchers assessed the act's potential economic effects on Pennsylvania, factoring in an optional expansion of Medicaid, and found the state would enjoy significant net benefits. With or without the expansion of Medicaid, the act will increase insurance coverage to hundreds of thousands of Pennsylvanians, but the COMPARE model estimates that the expansion of Medicaid eligibility would cover an additional 350,000 people and bring more than $2 billion in federal spending into the state annually than if the state did not expand. Should the state expand Medicaid, the additional spending will add more than $3 billion a year to the state's GDP and support 35,000 jobs. But Medicaid expansion is not without cost for the state; the estimated cumulative effect on Pennsylvania's Medicaid spending will be $180 million higher with the expansion than without between 2014 and 2020. Substantial reductions in uncompensated care costs for hospitals are possible even without expansion, but savings to hospitals for uncompensated care funding are even larger with the Medicaid expansion,amounting to $550 million or more each year.
