Alan Weil, executive director of the National Academy for State Health Policy, foresees growing tensions between states and the federal government in the implementation of the Affordable Care Act relative to the law’s expansion of Medicaid eligibility, the creation of state health benefit exchanges and new rules governing individual and small group health coverage that supersede traditional state authority over these market segments.
To ensure cooperative federal-state relations and to avoid a merry go round of numerous state requests for federal relief from ACA requirements amid fiscal frugality at both levels of government, Weil proposes the feds and the states share cost savings generated by ACA mandates. Under Weil’s optional shared savings program, the federal government would share with the states any savings compared federal cost projections for programs that have federal financial participation. Weil suggests the scope of the program include Medicaid, the Children’s Health Insurance Program, and the state exchange marketplace.
Weil’s proposal published today in the journal Health Affairs can be read here.
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