RESUMO
Issue: The Affordable Care Act has expanded coverage to 20 million newly insured individuals, split between state Medicaid programs and commercially insured marketplaces, with limited integration between the two. The seamless continuum of coverage envisioned by the law is central to achieving the full potential of the Affordable Care Act, but it remains an elusive promise. Goals: To examine the historical and cultural differences between state Medicaid agencies and insurance departments that contribute to this lack of coordination. Findings and Conclusions: Historical and cultural differences must be overcome to ensure continuing access to coverage and care. The authors present two opportunities for insurance and Medicaid officials to work together to advance the continuum of coverage: alignment of regulations for insurers participating in both markets and collaboration on efforts to reform the health care delivery system.
Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Trocas de Seguro de Saúde/organização & administração , Cobertura do Seguro/organização & administração , Programas de Assistência Gerenciada/organização & administração , Medicaid/organização & administração , Patient Protection and Affordable Care Act/organização & administração , Definição da Elegibilidade , Setor de Assistência à Saúde , Humanos , Seguro Saúde/organização & administração , Reembolso de Seguro de Saúde , Setor Privado , Setor Público , Governo Estadual , Estados UnidosRESUMO
States have long been the testing ground for new models of health care and coverage. Section 1332 of the Affordable Care Act, which takes effect in less than two years, throws open the door to innovation by authorizing states to rethink the law's coverage designs. Under State Innovation Waivers, states can modify the rules regarding covered benefits, subsidies, insurance marketplaces, and individual and employer mandates. States may propose broad alternatives or targeted fixes, but all waivers must demonstrate that coverage will remain as accessible, comprehensive, and affordable as before the waiver and that the changes will not add to the federal deficit. This issue brief describes how states may use State Innovation Waivers to reallocate subsidies, expand or streamline their marketplaces, replace or modify the mandates, and otherwise pursue their own brand of reform tailored to local market conditions and political preferences.
Assuntos
Reforma dos Serviços de Saúde/economia , Benefícios do Seguro/economia , Cobertura do Seguro/economia , Inovação Organizacional/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Trocas de Seguro de Saúde/economia , Trocas de Seguro de Saúde/legislação & jurisprudência , Benefícios do Seguro/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Patient Protection and Affordable Care Act , Governo Estadual , Estados UnidosRESUMO
Pitched battles over aspects of the law will continue, but the fundamental reality is that stakeholders are fully engaged, and implementation will move ahead.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Unidades de Terapia Intensiva/organização & administração , Patient Protection and Affordable Care Act/legislação & jurisprudência , Qualidade da Assistência à Saúde/economia , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Política de Saúde , Humanos , Unidades de Terapia Intensiva/economia , Formulação de Políticas , Política , Estados UnidosRESUMO
In the aftermath of the Supreme Court decision largely upholding the constitutionality of the Affordable Care Act, many stakeholders have renewed their commitment to health care reform. In fact, a new political economy of health care has emerged that is characterized by three dynamics. One is the "log-rolling" dynamic of distributive politics, as evident in mutually supportive efforts for maintenance and expansion of subsidies and other opportunities to advance the interests of stakeholders. A second is the cut-throat zero-sum politics of interest-group conflict, as evident in the intense competition among stakeholders for limited resources and authority. The third dynamic is the result of the emotional and ideological conflicts of resource redistribution. These new dynamics may make repeal of reform more daunting than expected.