Ladies and gents, one of the things that has perplexed me since I moved to the new site this last July is the lack of comments. Well, it turns out that the blog’s comment functionality was set up wrong (yes, by myself). This problem is now fixed and last week, we got our first comment. Please feel free to join in the conversation as well. Thanks. ~BAA
2 comments:
Brady what do you think of the Cantwell amendment to the Baucus bill that allows states to opt to buy care for persons between 133-200% FPL in a "federally-funded non-Medicaid state plan"? The focus has been on bringing coverage up to 133% FPL, but some states use Medicaid funding for health care reform waivers that purchase coverage for people way above that FPL. Is this the death knell for Medicaid FMAP for people over 133% FPL? Is playing with the subsidy $$ with fewer coverage mandates actually a better deal for states than FMAP (but likely less of a deal for recips?)
@Anonymous. First off, thanks for the question. It's a really good one. Here's my thoughts on the topic.
I am not a big fan of the Cantwell amendment and do not expect it to survive. Why? Well, as the recently released Commonwealth Fund pointed out, there is unjustified variation between states when it comes to coverage and performance. [See http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/2009-State-Scorecard.aspx] Letting states choose whether and how to set up their individual Public Options will just magnify these variations. Personally, I think a level-playing field across all states with an option for states to opt-out and expand is a better idea. [See http://www.huffingtonpost.com/2009/10/07/dems-discussing-public-op_n_313054.html]
On your question as to how this affects Federal match for those states with 1115 Research and Demonstration waivers that allow them to use savings from one part of Medicaid or other HHS programs and apply them to populations not normally covered by Medicaid, I do not expect that to change.
1115 waivers are very broad in scope and encompass Medicaid, SCHIP, as well as other programs authorized by the Social Security Act. One little known fact is that the waiver authority precedes enactment of Medicare and Medicaid. Since these waivers are required to be "budget-neutral," if the Federal government took away the ability of states to include persons making 133 to 200% FPL, states might gain from a budget perspective but lose from an economy perspective (because of the lost Federal match). Also, persons who fall between 133 and 200% FPL would be worse off because their premiums and cost-sharing would go up. As the old saying goes, if it ain't broke don't fix it. A state-based public option could sit on top of an 1115 and provide another option for individuals but I do not expect that states would be forced to excise this population from 1115 waivers. Again, thanks for the question. ~BAA
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