HLTH 385 Lecture Notes - Lecture 9: Co-Insurance, Payroll Tax, Medicare Advantage
21 May 2018
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• Reviewed the Oregon Medicaid Experiment
o People who won Medicaid coverage, care and costs of care went up or use of
care went up
• Also unhealthy habits went up- like smoking
o Some of the up usage in healthcare or negative health habits wasn't
statistically significant
o Not many changes in positive health outcomes even though these people
were using more healthcare
• Depression and mental health did improve
• Similar to RAND health experiment results
• Block Grants- under proposal, challenges facing Medicaid
(http://kff.org/medicaid/issue-brief/5-key-questions-medicaid-block-grants-per-
capita-caps/)
o Republicans want to turn Medicaid into a block grant program
o Currently federal government pay 50%-75% of costs
• Federal government closely regulates who is eligible for Medicaid and
what is covered under Medicaid
o Under block grant program, federal government would give states a lump
some of money at the beginning of the year that would go towards covering
healthcare costs
• No longer a fixed percentage of costs
Regulation government will have over who is eligible for Medicaid and
what is covered under Medicaid will no longer exist--> states can spend
the money how they want to
o Current rate of increase(in federal government spending on healthcare)=
f(beneficiaries, spending per beneficiary)
o Current rate of increase (w/ federal government under block grant)=
f(inflation rate)
o Some states that expanded Medicaid got more money
• Video on Pro-block grant argument (could be on final!!)- promote federalism and
replicate the success of welfare reform with Medicaid block grants
o Medicaid is a budget buster
o Government should abolish Medicaid and establish block grants
o Cap federal Medicaid spending
o Block grant federal funds to the states
o Allow states to take control over how to spend money
• Give state politicians the full authority to determine how to allocate
dollars
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