Impose Caps on Federal Spending for Medicaid: Physician Care Services

The Federal government provides budget objectives for healthcare through healthcare programs, subsides through reduction in federal taxes initiatives and spending through a discretionary appropriation, but many of the health options can be seen as transformative in retrospect to what it will do to establish development within the success of trends for healthcare. Imposing caps on Federal spending for Medicaid is one options that can challenge enrollment coverage, variations within state per capita income and cost sharing objectives under the Affordable Care Act for optional expansion.

           Physician visits is a service that could be widely impacted by this option because of physician’s care being the first point of service within a managed care organization, many patients who lose their group insurance under an employer due to termination or lay off and is eligible to receive Medicaid services thereafter, may not get coverage due to affordability although COBRA is an instant option as well. COBRA services allow employees to maintain group private insurance coverage but the premiums increase at the double the cost because employee take on their former employers share of the cost to insurers. Currently, Federal funding for Medicaid is open-ended under the ACA because if a state spends more because enrollment increases or cost per enrollee, Federal funding is than increased to accommodate those who need coverage during a special enrollment periods.

           Private insurance is another reason that caps shouldn’t be implemented to Federal Funds when it comes down to Medicaid coverage because of the yearly premium increase many consumers have been experiencing. Within one fiscal year, it has become very difficult for consumers to reach the deductible for the year and in turn they end up struggling to pay for the co insurances to maintain coverage. This is another reason many people utilize healthcare services like Medicaid under the ACA in which is partially Federally funded as well. A per capita cap is intended to reduce the amount and variability of federal Medicaid expenditures and provide states with an incentive to reduce Medicaid costs (Goodman-Bacon PhD & Nikpay PhD MPH, 2017).

           However, this is substantially necessary in order to contain spending within the healthcare system, but how does proposing under the bill (Better Care Reconciliation Act (BCRA) to lower the Federal matching rate for the ACA expansion population from the enhanced level of 90 percent to state specific rates; which are regulated for most Medicaid spending ranging from 50 percent to 75 percent for low income states? (Capretta, 2017). How does this provide a quality driven healthcare system in which is patient focused when an open ended Federal budget was created because there isn’t real data to depict what percentage of patients will require Medicaid services?

           What I gather from this option is a relation to a quick fix solution in which counter acts from one operable sector to the next. According to the CBO (Congressional Budget Office), they believe if caps are set below current projections for Medical spending, savings would be difficult to acquire. CBO expects states to structure their programs to qualifying cap funding limits in order to accommodate the shortfalls (CBO.gov, 2016). What I propose should take place to ensure physician care services stay consistent with a patient quality care agenda is for consumers who seek healthcare coverage through the market place their coverage benefits and payments should be reevaluated to help decrease the budgetary needed from the federal government in that area.        

           A cap should be slowly implemented and provide incentives to insurers, that can help regulate premiums in which contract negotiations should specify a fixed premium over a duration of time for patients. Also, no caps should be given to eligible Medicaid patients who qualify for CMS services, but instead allocate for spending by restructuring the way financing is addressed state to state. Meaning, Medicaid enforcements within funding should come from understanding data anaylsis for state to state within those funding needs, the programs allocated for and what areas can benefit from measurements that won’t affect providing networks, quality assurance and covered services. I think the objective is how can we ensure patients can be covered without going further into debt and that would be to evaluate on a state local level the possibility of reducing rates to providing services rendered and add a greater incentive or create programs that helps patients in the Medicaid program become more involved in their care to add a preventive care component to reduce particular service needs and potential cost as a mandate for being in the program.

Capretta, J. (2017). The GOP Is Right: Medicaid Needs Fundamental Reform. Retrieved from           https://www.nationalreview.com/2017/06/medicaid-reforms-senate-health-care-bill-  medicaid-reforms-important-step/

CBO.gov. (2016). Impose Caps on Federal Spending for Medicaid. Retrieved from https://www.cbo.gov/budget-options/2016/52229

Goodman-Bacon PhD, A. J., & Nikpay PhD MPH, S. S. (2017, March). Per Capita Caps in   Medicaid — Lessons from the Past. The New England Journal of Medicine, 376(), 1005-      1007. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMp1615696