Medicaid has evolved from its modest beginnings to become the nation's primary health insurer for low-wage individuals. The program today covers nearly 70 million Americans, at a cost of roughly $440 billion (17 percent of the nation's overall health care bill). It pays for the young (nearly 50 percent of the nation's births) and the elderly (40 percent of the long-term care bill) and for the care rendered to poor and working families across the life span. As Medicaid has grown, so too has the complicated intergovernmental program partnership: there is ongoing intergovernmental bargaining over program eligibility, benefits, and reimbursement, and significant interstate variation in these and other program features. Perhaps surprisingly, however, there are relatively few in-depth qualitative analyses of the substance and the politics of the program and even fewer that examine in-depth program implementation in particular states. Block Granting...
Block Granting Medicaid: A Model for Twenty-First Century Health Reform?
Michael S. Sparer is professor and chair in the Department of Health Policy and Management at the Mailman School of Public Health at Columbia University. Professor Sparer researches the politics of health care, with a particular emphasis on the health insurance and health delivery systems for low- and middle-income populations, both in the United States and globally. His current projects include a study that evaluates the implementation of the insurance exchanges created by the ACA, an examination of organizational and political dynamics that encourage successful accountable care organizations, and a book that examines the role of federalism in health politics. Sparer is the former editor of the Journal of Health Politics, Policy and Law and the author of Medicaid and the Limits of State Health Reform (1996), as well as numerous articles and book chapters.
Michael S. Sparer; Block Granting Medicaid: A Model for Twenty-First Century Health Reform?. J Health Polit Policy Law 1 October 2015; 40 (5): 1107–1111. doi: https://doi.org/10.1215/03616878-3161236
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