Medicaid Everyone Can Count on Public Choices for Equity and Efficiency

A comprehensive policymaker's guide to the Medicaid program, Medicaid Everyone Can Count On offers unique insights into the complex interactions among stakeholders in America's state-based public health care programs. In an era of national health care reform, this volume is an invaluable resource for federal and state lawmakers and program analysts tasked with crafting policies that balance the distinct needs of taxpayers, providers, and the poor. Working from theory to practice, Thomas W. Grannemann and Mark V. Pauly develop an approach to Medicaid policy based on a keen understanding of the forces that have shaped the program. They begin by examining the program's intellectual foundations--American altruism and the principles of equity, efficiency, and democracy. They then ask the question: What are the inherent strengths and weakness of the American approach to financing medical care for the poor? The answers it turns out have direct implications for how best to approach implementing health reforms that would extend eligibility, control costs, and provide better value both to program recipients and to taxpayers. Building on the theory of public choice and economic analysis, the authors offer new perspectives on the program and its flaws, including unequal benefits among the states, federal funding that is poorly matched to state needs and resources, and disparities in payment to health care providers. To correct these flaws reform initiatives need to focus on two leverage points--federal financing and provider payment--that control the flow of resources and influence the behavior of states and medical care providers. The authors offer suggestions for using these tools to address policy issues in areas such as eligibility, benefits, care management, provider incentives, and federal assistance to the states. At this transitional point in the program's history, Grannemann and Pauly provide a consistent framework for thinking about Medicaid policy, one which has many practical implications for policy