Title: Medicaid And Health Reform: The Case Of New York
Abstract: Prologue: Medicaid is a major culprit in rising health care costs. The program s expenditures increased by 13 percent in 1989, 18 percent in 1990, 27 percent in 1991, and 30 percent in 1992 to reach $120 billion. Medicaid has often crowded out other items in states' budgets; New York, for example, has decreased its public education spending by 5 percent in the past two years. The Kaiser Commission on the Future of Medicaid has attributed Medicaid's rising costs to increased enrollment in the program (the costliest portion being additional elderly and disabled beneficiaries), increased medical costs in general, and a higher outlay per beneficiary, reflecting both a sicker population and efforts to keep up with private payers' reimbursement rates. Any health care reform proposal will clearly need to address this cost crisis. Yet author James Fossett argues in this paper that “the largest and most rapidly growing parts of Medicaid are outside the jurisdiction of most currently discussed health reform plans.” Using New York as a case study, he shows that the practice of shifting various state programs onto Medicaid to receive matching federal dollars has resulted in a category of “Medicaided” programs beyond the scope of health care reform. Also, approximately 30 percent of Medicaid spending goes to elderly beneficiaries' long-term care, which is not included in most health care reform proposals. Yet these are costly aspects of the Medicaid program. “The forces that have caused rapid Medicaid growth in New York and similar states are not the same as those that have produced rapid growth in total health expenditures,” warns Fossett. Medicaid requires a separate reform effort. Fossett is an associate professor at the State University of New York's Graduate School of Public Affairs and School of Public Health in Albany. He holds a doctorate in political science from the University of Michigan. Abstract: New York State has the largest, most expensive state Medicaid program in the country. Thus, an examination of its Medicaid program can offer valuable lessons for other states that are considering reform of their health systems, as well as for reform at a nationwide level. Much recent growth in Medicaid in New York stems from shifting state-funded human service programs onto Medicaid and shifting the state's share of Medicaid onto nontraditional revenue sources. In contrast to other states, in which Medicaid is an unpopular program, New York's Medicaid provider constituency is large and diverse, and its clientele is relatively white and middle class. These two constituencies have made Medicaid harder to cut than in other states, in which Medicaid recipients lack political and economic clout. Current versions of national health reform will have little effect on Medicaid spending in New York, since they address neither spending on the elderly nor the “Medicaiding” of programs and revenue sources.
Publication Year: 1993
Publication Date: 1993-01-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 7
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