The Medicaid and Medicare law is now half a century old
Why should focus be placed on the law of Medicaid and Medicare? From a policy perspective, these two programs have always been analyzed but one of the significant changes which were brought about after the 1965 legislation was the bringing of 2 major federal statutes and along with them 3 additional branches of government within the center of health care and its regulation. Congress has also passed laws relating to health prior to 1965 however until Medicare and Medicaid, most of the policies were made at the local leave, by the medical profession on its own as well as by the state courts and governments.
Along with Medicare and Medicaid came Congress and the Supreme Court as well as the lower federal courts into the picture. It also caused the Treasury, Department of Justice and Health and Human Services to become major players within the sector of health policy and management. Despite this, there has been very little reflection on features of the law has affected the success and development of these programs’.
If there was to be any doubt regarding the significance of these, one can simply look at the Affordable Care Act of 2010 and wouldn’t have to look any further. This is the largest federal intervention in history which has occurred in terms of health policy. This Act has caused a lot of attention to be paid to the role of the federal government with respect to health policy however it has also built squarely on the policy and law which Medicare and Medicaid wrought.
All of this leads to some issues, one of which includes fragmentation. Policymakers usually turn towards federal law to bring coherence and uniformity within a policy arena. Within health law, the regulatory landscape is not one which is steady particularly with respect to how health care is paid for as well as regarding how it is regulated. Additionally it isn’t very clear as to what Medicare and Medicaid have done in addressing these problems. Both programs have certainly conducted experiments in bundled payment reform and the ACA too has conducted similar experiments. But such moves are still needed to be spread throughout the private sector and even between programs.
Another thing to consider is whether or not federal intervention over the past 50 years has helped in the innovation and experimentation in comparison to what a state driven system would. While Medicare has used the power it has in the market to drive payment and delivery reforms, Medicaid has used its waiver provisions to incentivize a number of important policy experiments.
Thirdly, it should also be kept into consideration that with federal intervention comes a change in the enforcement and implementation of health law and Congress is now a central player. It implements these laws through statutory amendments, budget rules and administrative oversight. But a question arises as to how the requirements of Congress of mandatory spending on Medicaid and Medicare have affected the development of both these programs? Cost control thus continues to be a political batter particularly with respect to Medicare.
Lastly the role of the government should also be looked into. The one question which has been popular has been that pertaining to the proper allocation of power between the federal government and the states and this applies to health law as well. The center of gravity in health has decided in moving away from the states and more toward the federal government with the movement beginning in 1965 and now culminating in the ACA. Thus it isn’t difficult to see that such legal issues have an impact on how the health policy is shaped.