Today, the United States Congress is considering significant structural changes to the Medicaid program, including caps on the federal financial commitment to Medicaid commonly known as per capita caps or per capita allotments. This proposed change is advancing as part of the legislation aimed at repealing the Affordable Care Act. With attention and debate focused on repeal of the 2010 law, per capita caps’ impact on the 11 million Medicare beneficiaries who also receive Medicaid benefits has seen less attention and consideration than it otherwise might.
Better care for these high-need individuals is an indispensable element of any serious effort to slow the growth of health care spending while improving quality.
More Americans comparison-shop for their auto mechanics than for their doctors. Yet, prices for health care services vary greatly within geographic areas and are not consistently linked to quality. This indicates that if consumers were empowered to choose high value providers and services, they could receive better care and save money. Within the U.S., the increasing prevalence of high deductible health plans and health savings accounts along with continued upward price trends makes it imperative for consumers to spend their health care dollars wisely. Lack of price and quality transparency presents a major barrier to consumer engagement. Access to information is only a first step, though. Value-based insurance design, which aligns consumers’ incentives with value, can further improve health care outcomes and affordability.
Medicare beneﬁciaries are being denied access to Medicare’s skilled nursing facility (SNF) beneﬁt because of the way hospital stays are classiﬁed.
As American health care transitions from volume to value, successful employers, plans, and health systems are finding strong primary care to be absolutely essential. Yet nationally, the United States spends only 4-8% of health care dollars on primary care, compared to an average of approximately 12% among other industrialized countries1 – each of which spends substantially less on health care than the United States. To build an American health care system that delivers better care at a lower cost, primary care must become a national health policy priority.