Reform Medicaid First: Laying the Foundation for National Health Care Reform [Paperback]

Thomas W. Grannemann (Author), Mark V. Pauly (Author)

Book Description

Publication Date: June 2009

As Congress contemplates major revisions to America's health care system, two leading health economists warn that significant differences among state Medicaid programs will hinder national health care reform. Thomas W. Grannemann and Mark V. Pauly argue that Medicaid will need to be reformed as an early step in any serious health care reform effort. While states such as Mississippi and Nevada spend as little as $5,000 per poor person annually, New York and Alaska annually spend more than $15,000 per Medicaid patient. Large differences remain even after correcting for cost-of-living and medical-price differences. This imbalance among states creates an uneven and unstable foundation for any national program to address the needs of uninsured Americans. The authors offer principles for reform designed to encourage equity, efficiency, and accountability in all publicly funded health care programs. They suggest changes in provider payment methods and federal/state financing designed to promote interstate equity, equality of payment across settings, claims-based accountability, provider network control, and value-based cost containment. Such reform will require upfront changes in Medicaid to improve access to high-value health care for low-income persons (particularly those in low-Medicaid-benefit states) and to help slow the rate of growth in medical costs. These changes will level the playing field for state programs and provide a crucial foundation for further national reform.

Editorial Reviews

About the Author

Mark V. Pauly is a professor in the Health Care Management Department at the University of Pennsylvania's Wharton School. Thomas W. Grannemann is a health economist and an associate regional administrator for the Centers for Medicare and Medicaid Services in Boston.

Mark V. Pauly is a professor in the Health Care Management Department at the University of Pennsylvania's Wharton School.

Thomas W. Grannemann is a health economist and an associate regional administrator for the Centers for Medicare and Medicaid Services in Boston.

Product Details

• Paperback: 62 pages
• Publisher: Aei Press (June 2009)
• Language: English
• ISBN-10: 084474316X
• ISBN-13: 978-0844743165
• Product Dimensions: 8.4 x 5.6 x 0.2 inches
• Shipping Weight: 4 ounces (View shipping rates and policies)
• Average Customer Review: 3.5 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #1,423,993 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

2.0 out of 5 stars Period Piece, November 13, 2011

By 

David Holoman (Raleigh, NC USA) - See all my reviews
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This review is from: Reform Medicaid First: Laying the Foundation for National Health Care Reform (Paperback)

The first thing to know about this book is that is was written during and for a particular time. It was written between the time President Obama took office and the time the Patient Protection and Affordable Care Act (PPACA, sometimes referred to as Obamacare) was passed. Some of the concepts continue to be applicable; others have been overcome by events. I think it likely that it was required reading for the policy makers laboring in the forges that cast the PPACA.

The premise of the book is that universal health care is so big a change that it must be conducted in increments, working from what we have and adding eligibility and benefits to a population not currently covered by Medicaid and CHIP. The authors draw a clear distinction about a taxpayer's feelings about his/her state taxes arriving in the pocket of a member of the state as opposed to federal tax dollars arriving in the same pocket. I don't doubt that their research is accurate, but I think it is a curious state of affairs to consider federal tax money to be such a different beast from state taxes *from the taxpayer's point of view.* The authors are persuaded that the benevolence of taxpayers decreases rapidly as the beneficiaries' income approaches the contributors' income.

So, problem. One solution from the authors' standpoint is to standardize the amount of support that the fed gives to states. That is, to reduce benefits to high benefit states and raise benefits in low benefit states. And savings will emerge.

From first hand experience, it is one thing not to offer a Medicaid benefit; another altogether to remove or reduce an existing benefit. Moreover, to bring uniformity to the states' Medicaid programs will defeat the laboratory feature of separate state programs, the feature that produced the Massachusetts model that became the basis for the PPACA. Vermont also has a promising experiment in the works. It is unclear what mechanism will replace innovation in the states in a consolidated system.

It seems to me that a more equitable distribution of federal Medicaid funds to states is the extent of the authors' true desire. Any advance farther than that toward a coordinated federal plan is fraught with difficulties that the authors identify ably.

The authors seem to argue against their premise on page 15 (note that the work is 47 pages) that there is not a path from Medicaid expansion to a generalized health care system. Elsewhere they describe the difficulties with bending the cost curve. In another place it is stated that we can never afford universal coverage if costs stay on their current trajectory. And late in the book, they come perilously close to saying something to the effect that there might not be enough of other peoples' money to go around.

Today, mechanisms that have the potential to bend the cost curve are emerging, notably the rise of super-practices (and their policy cousins, Accountable Care Organizations (ACOs), and capitation of coverage rather than fee-for-service.

Now that the PPACA is passed, states' chief concern is gearing up for the additional recipients, implementing HITECH, and gearing up their Health Benefits Exchanges.

1 of 2 people found the following review helpful:

5.0 out of 5 stars Before we "fix" the whole system, let's do a simpler thing and fix medicaid, August 18, 2009

By 

Craig Matteson (Saline, MI) - See all my reviews
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This review is from: Reform Medicaid First: Laying the Foundation for National Health Care Reform (Paperback)

Since the reason underneath the remaking of American Health Care is supposed to be taking are of the poor who can't seem to get insured it would make sense to take a close look at Medicaid, our expensive program to care for the medical needs of the nation's poor. Thomas Grannemann and Mark Pauly are economists who specialize in healthcare and they have provided us with this monograph to help us understand what is going on in Medicaid today and why we must begin by reforming Medicaid before setting out to fix healthcare or we will not get to the real issue, which is supposed to be caring for those in need.

They show the tremendous disparity in providing Medicaid and explain why equalizing Medicaid payments must be done before you attempt anything else to change health care in America. In fact, if we do a good enough job in caring for the poor and make a few adjustments to existing insurance, such as portability, equalizing tax treatment for individuals buying health insurance and employer based care, and a possible few others and we won't need Obamacare (this last sentiment is mine).

The authors offer this checklist: "interstate equity, equality of payments across settings, claims-based accountability, provider network control, and value-based cost containment. They wisely urge us to be clear about what we want to end up with and take a slow and deliberate approach towards our health-care rather than the rash process being attempted against us now.

Reviewed by Craig Matteson, Ann Arbor, MI