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How fair is Medicaid to the poor, to providers, and to taxpayers? Intended as a welfare program for the poorest and most severely disabled members of society, the Medicaid program today is crippled by major inequities that threaten to violate that promise. Even before proposed Medicaid expansions that could add
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15 million new beneficiaries, every state legislature is now struggling to find a balance between fiscal prudence and efficient delivery of medical services. Medicaid today presents a major challenge to state governors who are faced with an increase in the demand for Medicaid services and declining state revenues. It is imperative, therefore, to examine the Medicaid program, how it functions, and how it ought to be reformed.
Health economists Thomas W. Grannemann and Mark V. Pauly do just that in their new guide to the Medicaid program, Medicaid Everyone Can Count On: Public Choices for Equity and Efficiency (AEI Press, March 2010). This comprehensive study is guided by one fundamental question: what would health care programs for the poor look like if they were based on principles of equity, efficiency, and accountability? Today's Medicaid is flawed by unequal benefits among the states, federal funding that is disproportionate to state needs and resources, and disparities in payment to health care providers. Rectifying these flaws will require substantial changes in the way the program is financed and how it pays providers.
At this AEI event, Grannemann and Pauly presented their findings and explained how a new approach to federal financing and provider payments might improve the flawed incentives that now make the Medicaid program both inequitable and inefficient. John Colmers, Maryland secretary of health and mental hygiene, and Colleen M. Grogan, an associate professor in the School of Social Service Administration at the University of Chicago whose fields of special interest include health policy and health politics, discussed the authors' proposal. AEI's Robert B. Helms moderated the discussion.
| 9:00 a.m. |
Registration and Continental Breakfast | |
| 9:30 | Presenters: | Thomas W. Grannemann, Andover Economic Evaluation |
| Mark V. Pauly, University of Pennsylvania | ||
| Discussants: | John M. Colmers, Maryland Department of Health and Mental Hygiene | |
| Colleen M. Grogan, University of Chicago | ||
| Moderator: | Robert B. Helms, AEI | |
| 11:30 | Adjournment |
American Enterprise Institute
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Speaker biographies
John M. Colmers is the secretary of the Maryland Department of Health and Mental Hygiene. This cabinet level agency has a budget of $8 billion and nearly seven thousand employees. From November 2000 through January 2007, Mr. Colmers was a senior program officer for the Milbank Memorial Fund. The New York–based Milbank Memorial Fund is an endowed national foundation that provides nonpartisan analysis, study, research, and communication on significant issues in health policy. Prior to joining the fund, he spent nineteen years in Maryland state government where he held various positions, including executive director of the Maryland Health Care Commission and the Health Services Cost Review Commission, the agency overseeing Maryland’s hospital rate–setting system.
Thomas W. Grannemann is associate regional administrator for Medicare Financial Management and Fee-for-Service Operations in the Boston Regional Office of the U.S. Centers for Medicare and Medicaid Services. Previously, he served as the chief of the Bureau of Economic Analysis and Rate Setting Policy with the State of New Hampshire Office of Medicaid Business and Policy. Mr. Grannemann also taught health economics, health policy, and public finance at the University of Colorado’s Graduate School of Public Affairs; managed his own research and consulting business, Andover Economic Evaluation; and served as a senior economist at Mathematica Policy Research Inc.
Colleen M. Grogan is an associate professor in the School of Social Service Administration (SSA) at the University of Chicago. Her fields of interest include health policy and health politics, the American welfare state, comparative state-level policy and politics, and empirical studies of participatory decision-making processes. Her forthcoming book project examines the political history of the Medicaid program. It attempts to explain changes in legislation and political discourse over time, examines policy feedbacks within the program, and assesses Medicaid's potential to act as a stepping stone to universal coverage in the United States. Ms.Grogan joined the SSA faculty in 1999 after serving as an assistant professor in the department of epidemiology and public health at Yale University, where she also held a joint appointment with the Institution for Social and Policy Studies. She is a recipient of the Robert Wood Johnson Health Policy Investigator Award.
Robert B. Helms has served as a member of the Medicaid Commission as well as assistant secretary for planning and evaluation and deputy assistant secretary for health policy at the U.S. Department of Health and Human Services. An economist by training, he has written and lectured extensively on health policy and health economics, including the history of Medicare, the tax treatment of health insurance, and comparisons of international health systems. He currently participates in the Health Policy Consensus Group, an informal task force that is developing consumer-driven health reforms. He is the author or editor of several AEI Press books on health policy, including Medicare in the Twenty-First Century: Seeking Fair and Efficient Reform (1999) and Competitive Strategies in the Pharmaceutical Industry (1996).
Mark V. Pauly is Bendheim Professor in the department of health care management, professor of health care management, insurance and risk management, and business and public policy at the Wharton School, and a professor of economics at the University of Pennsylvania. He is a member of the Institute of Medicine, an adjunct scholar at AEI, and an advisory committee member for the National Institutes of Health and the National Academy of Sciences. Mr. Pauly is coeditor in chief of the International Journal of Health Care Finance and Economics and associate editor of the Journal of Risk and Uncertainty.
