Disparate Treatment of
Eligible Populations Warrants Scrutiny, by Doug Badger, Senior Fellow, Galen
Institute
(https://www.mercatus.org/doug-badger?mc_cid=9dd2e5e43f&mc_eid=[UNIQID])
Most people agree that
Medicaid should help the poor, particularly those whose poverty is related to
their age and disability. However, the Affordable Care Act requires the federal
government to pay a much greater share of the medical bills for nondisabled,
nonpregnant adults than it does for elderly individuals, people with
disabilities, children, and pregnant women.
The share of state
Medicaid spending paid for by the federal government—known as the Federal
Medical Assistance Percentage, or FMAP—had remained relatively unchanged
throughout the program’s history until Congress and the executive branch
changed that share under the ACA, providing a strong incentive for states to
expand Medicaid coverage to this new population of nondisabled, nonpregnant adults.
The new FMAP formula and
expansions created two significant problems:
* The federal government
rewards states much more generously for providing services to individuals who
fit the new criteria than to individuals who arguably are more in need of assistance
* The Medicaid expansion
overlooks differences among states in their capacity to fund services for this
new population, benefiting states with high per capita income at the expense of
low-income states.
As it considers repeal
and replace legislation, Congress should reexamine this arrangement. Congress should seek to devise a Medicaid
financing structure that treats eligible populations equitably and recognizes
the differences in fiscal capacity among states.
The full paper is
available here:
Galen Institute, P.O.
Box 320010, Alexandria, VA 22320, USA
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