Congress to the States: Take Medicaid. Please!

By Pretzer, Michael | Medical Economics, June 26, 1995 | Go to article overview

Congress to the States: Take Medicaid. Please!


Pretzer, Michael, Medical Economics


Is Vermont's governor, Democrat Howard Dean, being set up? He says he's not certain. But it sure looks like the GOP's quest for a balanced budget, which necessitates a healthy cut in Medicaid, will put Dean and other state leaders in a precarious situation.

To lower Medicaid's cost, congressional Republicans want to transform Medicaid from a federal entitlement program to a system of block grants to the states, with fixed annual increases. The GOP intelligentsia argue that their motives are pure, that by giving grants to the states, along with expanded authority to do such things as restrict Medicaid patients to managed care, they'll help make health-care delivery more efficient and less costly.

Au contraire, say the plan's deriders. The Republicans are just passing the buck--in more ways than one. Their idea of block grants is fashioned mostly to take Congress off the hook while turning governors and state legislators into Medicaid's hit men. As Congress clamps down on Medicaid over the next few years via caps on the grants, Dean and his colleagues will have to make--then take the heat for--cuts in Medicaid fees, services, and enrollment.

One thing that's seldom disputed, however, is that Medicaid, jointly funded by the federal and the state governments to provide acute and long-term care to the poor, is too expensive. According to projections by the Congressional Budget Office, Medicaid will run up a $158 billion bill in fiscal 1995, with the federal government picking up between 50 percent and 79 percent of the tab in each state. (The percentage depends on a state's per capita income.) The Feds' Medicaid share is about half the size of the Medicare budget. But according to CBO, over the next five years Medicaid will grow between 10 percent and 11 percent annually. That's too much, say the Republicans. To get the budget balanced, the increase will have to be cranked down to between 4 percent and 5 percent a year, saving Washington about $180 billion over seven years.

Medicaid's expected growth makes governors and state legislators--Democrats as well as Republicans--nervous, too. Already, states spend more on Medicaid than on any other budget item, save elementary and secondary education. And in recent years, state outlays for education have been creeping downward, while Medicaid expenditures have been rising so fast that state revenues can't keep pace. That trend will continue for at least five more years, predicts the Kaiser Commission on the Future of Medicaid, a Washington, D.C., think tank funded by the Henry J. Kaiser Family Foundation.

Some states have tried to get a handle on their health costs by obtaining federal waivers of Medicaid rules. These have enabled states such as Arizona, Delaware, Hawaii, Kentucky, Ohio, Oregon, Rhode Island, and Tennessee to gain more managerial control of Medicaid and to move some beneficiaries into various managed-care systems. Many other states, including Dean's Vermont, have submitted waiver requests. For better or worse, the Republicans' plan for block grants would speed up the movement, expanding the potential for Medicaid managed care to all 50 states.

At first blush, the block-grant concept seems rather straightforward. Give each state a chunk of money and, within reason, let it devise a Medicaid program that's tailored to its specific circumstances. Inevitably, the current argument goes, a state's ship would be run tighter than the Feds'. Sure, some states may repeat Tennessee's mistake of jamming the Medicaid population into hastily assembled HMOs and PPOs (see the accompanying article). But the wiser states will take their cue from Minnesota, which spent three years planning for the Minnesota Prepaid Demonstration Project. They'll carefully phase in cost-controlled systems.

As with most health-care reform, the questions arise not from the concept, but from the specifics. One simple but potentially perplexing question for Congress: How many grants? …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Congress to the States: Take Medicaid. Please!
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.