Assignment: A demonstration Project
At the same time, state governments are concerned about their increasing Medicaid costs and about providing healthcare to uninsured people who are not eligible for Medicaid. Massachusetts passed legislation in 2006 to address some of these concerns. By 2010, the percentage of uninsured in Massachusetts had dropped to 6.3 percent from 10.9 percent in 2006. However, the deliberate absence of cost controls imposed by the state resulted in per capita health spending that was 15 percent higher than the national average (Kaiser Family Foundation 2012b).
Driven by increased Medicaid spending by the states, state governments are encour- aged to experiment with new delivery and financing mechanisms by filing a 1115 Medicaid waiver with the Centers for Medicare & Medicaid Services (CMS). In the waiver applica- tion, the state can ask permission for a demonstration project (typically for five years) that allows the state to fund or deliver care to Medicaid patients in that state in a unique way intended to improve access, quality, or both at a reduced cost (CMS 2016b).
While the ACA originally mandated that all states expand the eligibility for Medicaid from 100 percent of the poverty level to effectively 138 percent of the poverty level, the US Supreme Court ruled that mandate unconstitutional in 2012. To encourage states to expand Medicaid eligibility, the federal government offered to pay for 100 percent of the expansion cost for three years and 90 percent of the expansion cost thereafter. As of mid-2016, 31 states and the District of Columbia had accepted the offer (Kaiser Family Foundation 2017a).
nAtIonAl HeAltHcAre reform In March 2010, President Barack Obama signed into law the ACA and the Health Care and Education Reconciliation Act (HCERA), which made important modifications to the ACA. The law followed a century of debate on universal healthcare coverage and months of legislative maneuvering by Democrats and Republicans.
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