PUP 4931r Lecture Notes - Lecture 75: David L. Boren, Ed Koch, Materiel
16 May 2018
School
Department
Course
Professor
***The elderly and disabled are the most costly – reflects shift in focus
from short- to long-term care, the children the fastest growing, but least
costly.
Decentralization motivated by cost containment and innovation desires.
OBRA: fed. Contribution limited, stricter eligibility; allowed a different
stadard tha Mediare’s reasoale ost or. Allowed states to
determine which docs patients could see, made HMOs easier to use***.
David Boren (d- OK)
TEFRA: Tax Equity and Fiscal Responsibility Act – states can charge third
parties and beneficiaries a modest fee for services.***
Reagan wanted to cede authority for food stamp programs to state, gov’t
takes over Medicare: Ed Koh: a o jo, a sare ad a delusio, a steal y
the feds.
DRA (defecit reduction act): beneficiaries must cede rights to other
programs to Medicaid to help it meet costs for their health care. Could
these state-run programs maximize access while containing costs? DRA also
was first incremental step in increasing coverage and easing eligibility
standards
Interstate Variation
55 separate programs:
states, territories, DC
Huge variation in all features
Eligibility categories complex, arbitrary, some say discriminatory
half of pop in state optional categories
Many below poverty line still not eligible
Costs Out of Control
Doubled in past 15 years
From 10th to 5th of state spending
63% growth in past 5 years
Due to medical inflation, expanded eligibility****
State revenues falling due to recession
Expected annual growth 7.9 for coming decade
60% increase over decade ending 2017
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
***the elderly and disabled are the most costly reflects shift in focus from short- to long-term care, the children the fastest growing, but least costly. Decentralization motivated by cost containment and innovation desires. Contribution limited, stricter eligibility; allowed a different sta(cid:374)dard tha(cid:374) medi(cid:272)are"s (cid:862)reaso(cid:374)a(cid:271)le (cid:272)ost(cid:863) (cid:374)or(cid:373). Allowed states to determine which docs patients could see, made hmos easier to use***. Tefra: tax equity and fiscal responsibility act states can charge third parties and beneficiaries a modest fee for services. Reagan wanted to cede authority for food stamp programs to state, gov"t takes over medicare: ed ko(cid:272)h: (cid:862)a (cid:272)o(cid:374) jo(cid:271), a s(cid:374)are a(cid:374)d a delusio(cid:374), a steal (cid:271)y the feds. (cid:863) Dra (defecit reduction act): beneficiaries must cede rights to other programs to medicaid to help it meet costs for their health care. Dra also was first incremental step in increasing coverage and easing eligibility standards. Eligibility categories complex, arbitrary, some say discriminatory half of pop in state optional categories.
