57.2: Medicaid
Strengthening Medicaid in the States. Other Information:
Medicaid, as the dominant payer in the health market in regards to long-term care, births, and individuals with mental illness,
is the next frontier of welfare reform. It is simply too big and too flawed to be managed in its current condition from Washington.
Republican Governors have taken the lead in proposing a host of regulatory changes that could make the program more flexible,
innovative, and accountable. There should be alternatives to hospitalization for chronic health problems. Patients could be
rewarded for participating in disease prevention activities. Excessive mandates on coverage should be eliminated. Patients
with long-term care needs might fare better in a separately designed program. As those and other specific proposals show,
Republican Governors and State legislatures are ready to do the hard work of modernizing Medicaid for the twenty-first century.
We propose to let them do all that and more by block-granting the program to the States, providing the States with the flexibility
to design programs that meet the needs of their low income citizens. Such reforms could be achieved through premium supports
or a refundable tax credit, allowing non-disabled adults and children to be moved into private health insurance of their choice,
where their needs can be met on the same basis as those of more affluent Americans. For the aged and disabled under Medicaid,
for whom monthly costs can be extremely high, States would have flexibility to improve the quality of care and to avoid the
inappropriate institutional placing of patients who prefer to be cared for at home.
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