Health Care | Reseach

Welfare Block Grants as a Guide for Medicaid Reform

Daniel Sutter | Mar 21, 2013
Driven by the need to reform unsustainable entitlement programs, policymakers today are looking to the successful example of welfare reform—specifically, to its block grants to states. To inform this discussion, a new Mercatus Center at George Mason University study by Daniel Sutter reviews arguments in the debate over block grants versus matching grants for joint federal-state programs, examines the effects of shifting control of welfare programs to the states, and considers how the lessons from welfare reform can inform the current debate about Medicaid block grants.

The Affordable Care Act's Optional Medicaid Expansion: Considerations Facing State Governments

Charles Blahous | Mar 05, 2013
In the wake of a 2012 Supreme Court ruling, states face complex decisions concerning whether to expand Medicaid coverage to the full extent envisioned in the Affordable Care Act (ACA, commonly referred to as Obamacare). With the federal government no longer able to coerce expansion, states must base their decisions on value judgments that incorporate each state’s unique budgetary circumstances, the needs of its uninsured population, and the incentives established by interactions among the ACA’s provisions.

Medicaid Reform and Emergency Room Visits: Evidence from West Virginia's Medicaid Redesign

Tami Gurley-Calvez | Dec 18, 2012
Federal and state governments are under increasing pressure to limit Medicaid spending without negative health consequences. We examine a unique policy effort in West Virginia aimed at reducing spending and improving health through personal responsibility and preventive care. These efforts show promise for reducing emergency-room (ER) visits among those who chose the personal-responsibility plan but had the unintended consequence, at least in the short run, of increasing visits for those who defaulted into the plan with reduced benefits.

The Fiscal Consequences of the Affordable Care Act

Charles Blahous | Apr 10, 2012
The Affordable Care Act (ACA) enacted in 2010 will significantly worsen the federal government’s fiscal position relative to previous law.

The Fiscal Health of the States

Jeffrey Miron, Robert Sarvis | Feb 13, 2012
This paper examines the fiscal health of the states, focusing on two worrisome characteristics: an understatement of unfunded pension liabilities and ever-increasing expenditures, driven primarily by health care costs.

Beware the Rush to Presumption, Part B

Substandard Regulatory Analyses for the Affordable Care Act's Interim Final Rules
Jerry Ellig, Christopher J. Conover | Jan 09, 2012
This working paper finds that the quality and use of analysis for the ACA interim final rules falls well below that of conventional notice-and-comment rulemaking by other agencies, including HHS. The poor quality of analysis in the examined ACA rules is comparable to the quality of analysis that accompanied a series of interim final homeland security regulations issued by the Bush administration following 9/11. This suggests that institutional—rather than partisan—factors explain why the quality of regulatory analysis declines when agencies implement significant presidential priorities on short deadlines.

Beware the Rush to Presumption, Part C

A Public Choice Analysis of the Affordable Care Act's Interim Final Rules
Christopher J. Conover, Jerry Ellig | Jan 09, 2012
This working paper demonstrates that the low-quality analysis for the ACA regulations was a predictable result of the way that the administration and Congress chose to manage the regulatory process. Presidential and congressional decisions, in turn, reflected the political incentives both actors faced in 2010. To promote transparency and informed decision-making, additional checks and balances in the regulatory process are needed so politics will not short-circuit analysis.

The Poor Quality of Affordable Care Act Regulations

Christopher J. Conover, Jerry Ellig | Jan 09, 2012
This Mercatus on Policy catalogs the main deficiencies of the regulatory analysis for the ACA regulations and compares them to other economically significant regulations proposed in 2008 and 2009.

Beware the Rush to Presumption, Part A

Material Omissions in Regulatory Analyses for the Affordable Care Act's Interim Final Rules
Christopher J. Conover, Jerry Ellig | Jan 09, 2012
Federal agencies issued eight major “interim final regulations” in 2010 to quickly implement major provisions of the ACA. This working paper demonstrates that analyses for these regulations were seriously incomplete, often omitting significant benefits, costs, or regulatory alternatives. Analysis of fairness was cursory at best.

Rushed Regulation Reform

Christopher J. Conover, Jerry Ellig | Jan 09, 2012