After A $1T “All In,” Do You “Buy Back In,” Or Do A “Straddle?”

September 28, 2017

Almost immediately after the CBO released a "quick and dirty" impact of the Graham-Cassidy legislative impact (i.e $1T less in Medicaid spending with "millions" less covered), political support fell short of the requisite number of votes. In the aftermath, when will the Congress revisit essential elements like the Medicaid expansion, per capita caps, and block grants as part of the larger health reform efforts? 

In the absence of feasible legislation, what does Medicaid 2.0 look like? New proposals like a Medicaid buy-in have garnered a sizable amount of interest, although it is unclear if the implementation of such a policy would look like the previously proposed Nevada Health Plan (i.e. a private plan offering in the marketplace with a Medicaid-like benefits) or like something being developed by Senator Schatz (HI) (i.e. pay a premium to join, essential health benefits package, etc.)?

Otherwise, do States continue to pursue 1332 waivers perhaps couple with 115 waivers thereby creating a "super waiver"? Or do they exercise 1115 waiver authority to continue to add caveats to Medicaid coverage such as work requirements, co-payments, etc.? Finally, will we see an emergence of partial expansion coverage (i.e. adults only up to 100% FPL) like found in the Arkansas Works waivers submission?

Taking all bets....