Magazine article Policy & Practice

Health Care

Magazine article Policy & Practice

Health Care

Article excerpt


In the current political and fiscal environment, the state of America's health care has become an increasingly important topic of discussion. The number of uninsured individuals has risen significantly over the past decade, and the cost of health care services continues to increase faster than the rate of inflation. These issues, coupled with a shortage of skilled nurses, personal attendants, pediatric specialists, and primary care physicians, have created strong public sentiment regarding the need for health care reform. The American Public Human Services Association and its affiliate the National Association of State Medicaid Directors believe that the current health care delivery system should be modernized through investments in health information technology and through policies that promote individualized, coordinated, preventive care. These investments will create a system of value-based, transparent, quality care.


Across the country, Medicaid and the State Children's Health Insurance Program currently finance health care coverage to more than 50 million individuals, including children, low-income working parents, seniors, and individuals with disabilities. In 2008, when studies indicated that the number of uninsured individuals had decreased from the previous year for the first time in nearly a decade, the change was due to an increase in individuals covered by Medicaid and SCHIP Medicaid also represents the single largest payer for long-term care. The people on Medicaid are often too poor to afford insurance, or are individuals with expensive, chronic conditions who are unable to find or afford coverage in the private market. Medicaid and SCHIP provide a carefully administered and cost-effective health safety net for these vulnerable individuals, families, and children. Through these programs, states have extensive experience in addressing issues of health care quality, cost containment, and access to services. Medicaid and SCHIP programs frequently lead the nation in developing creative solutions to ongoing issues of access, quality, and cost.

Many, if not all, of the services provided through state Medicaid programs would increase in cost if they were administered privately. Despite criticisms of government programs, state agencies do an extraordinary job of administering Medicaid programs in an efficient and cost-effective manner, with an administrative cost of less than 3 percent of the overall operational budget. In comparison, many studies estimate private insurance and managed care organizations' overhead costs to be 20 to 25 percent or more of their overall expenses.


This record of accomplishments by the states cannot continue without several urgently needed changes. The topics and recommendations in this chapter deal with the immediate needs of state Medicaid agencies, as well as the ongoing opportunity for Medicaid agencies to be an integral part of health care reform. These recommendations fall into the following areas:

* Federal-state partnership;

* The future of SCHIP;

* Medicaid and SCHIP financing;

* Rebalancing long-term care;

* Medicare and Medicaid dual-eligible population; and

* Comprehensive health care reform.

Today, state Medicaid agencies are one of the most significant parts of the health care system in the United States. Medicaid agencies will continue to finance services to a significant (and growing) number of Americans and will strive to improve the value, efficiency, and quality of health services in the country. However, states need the active support of the federal government and a collaborative partnership based upon mutual trust and open communication.

Medicaid and SCHIP must have a crucial role in all the proposed health care changes currently under consideration if these changes are to be successful. …

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