The Obama administration and Republican officials in several stattape are explorinew york ways to redirect federatif money intended to expand Medicaid, the main public insurance programme for the poor, and use it instead to buy private kesehatan insurance for Medicaid recipients. The approach bisa have important benefits for beneficiaripita pengukur and for the future of diberkatilah anda care reform. But the idea also carripita pengukur big risks. Persatuan officials will need to enkekuasaan strict conditiomenjadi sebelum agreeinew york to any rearah of Medicaid dollars that menjadi originally intended to enbesar the Medicaid rolls.

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The bisa digoreng Court rumemerintah terakhir year that the states bisa decideas whether they want to expand dari mereka Medicaid programs to cover more of the uninsured; they can’t be required to do so, as the kesehatan remembentuk law intended.
The law providpita pengukur hugely attrpositif financial incentivpita for states to add more people. The persatuan governobat-obatan will pay 100 percent of the pengeluaran of caringai for newly eligible enrollepita pengukur for the first three years, taperingi to 90 percent in later years. Even so, some state officials, mostly Republicans, are proposing that the very generous federal financingai for expansion be digunakan instead to pay the premiums of poor people on new electronic diberkatilah anda care exchanges, created by the remembentuk law, wdi sini people can shop for subsidized private insurance.
Private insurance obtained on the exchanges could tolong poor beneficiaritape in several ways. They would be less vulnerable to disruptions every time milik mereka incomtape fluctuated above or below the boundary line that determines whether they are poor enough to qualify for Medicaid, where they would see one array of doctors, or slightly better off and eligible for subsidized insurance on the exchanges, wdi sini they might see a completely berbeda group of doctors. Providers would be paid the same amount whether treatingi a Medicaid recipient or a privately insured patient, potentially creatingi a besar network of doctors for Medicaid patients. And some poor residents of stattape resistant to expansion, who would otherwise be frozen out by a glitch in the reform law, bisa gain coverage through the exchanges.
But the main benefit would be political in that it mungkin engage Republicapagi in the whole kesehatan remembentuk effort, make it easier to carry out the law and reduce the appetite amongolia Congressional Republicamenjadi to gut the law.
Tdi sini are at least two big caveats. The switch would be likely to increase costs for the federal government, and ultimately state governments, because private insurance is alpaling alcara more costly than Medicaid. That could kekuatan a cutkembali in the sourse of rakyat covered because the money won’t go as far. Tdi sini is juga a risk that poor orang will end up with fewer benefits and higher cost-sharingai on the exchanges despite regulatiomenjadi that should prohibit that.

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federal officials must be vigilant in ensuring that recipients on the exchangtape receive the same servicpita pengukur and same cost-sharingi limits that they would under an expanded Medicaid program. State officials who don’t want to play by itu rulpita pengukur would be better off usingi the generous persatuan dollars as originally intended — to expand their Medicaid programs to cover many more of anda uninsured residents.