APA Public Interest Policy Office: April 14, 2005

Just as the Balanced Budget Act of 1997 called for the creation of the Bipartisan Commission on the Future of Medicare, the Medicaid program should also undergo a comprehensive and thorough review of what is and is not working and how to improve service delivery and quality in the most cost-effective way possible.

This legislation recognizes that determining the future of Medicaid is not simply about cost. While Medicaid is estimated to cost the federal government $188 billion in FY 2005, attention also should be given to the diverse population served. Over 50 million people receive care through Medicaid, including low-income seniors, people with disabilities, children, and pregnant women. Further, it is important to note that while costs are increasing, Medicaid is growing at a slower per capita rate than either Medicare or the private sector.

The Medicaid Commission would be charged with a number of duties, including reviewing and making recommendations with respect to the long-term goals, populations served, financial sustainability (federal and state responsibility), interaction with Medicare and the uninsured, and the quality of care provided.

Medicaid is a critically important program helping meet the health care needs of a diverse population through four different programs by serving as:

•  a source of traditional insurance for poor children and some of their parents;

•  a payer for a complex range of acute and long term care services for the frail elderly and people with disabilities;

•  a source of wrap-around coverage or assistance for low-income seniors and people with disabilities on Medicare, including coverage of additional benefits and assistance with Medicare premiums and copayments; and,

•  the primary source of funding to safety net providers that serve both Medicaid patients and the 45 million uninsured.

In recognition of this diversity, the bill's Medicaid Commission would be comprised of 23 members that reflect all the stakeholders and components in the Medicaid program. Those members include the following:

• One Member appointed by the President
• Two House members (current or former) appointed by the Speaker and Minority Leader
• Two Senators (current or former) appointed by the Majority and Minority Leader
• Two Governors designated by NGA
• Two Legislators designated by NCSL
• Two state Medicaid director designated by NASMD
• Two Local elected official appointed NACo
• Four consumer advocates appointed by congressional leadership
• Four providers appointed by congressional leadership
• Two program experts appointed by Comptroller General

The Commission has just one a year to hold public hearings, conduct its evaluations and deliberations, and issue its report and recommendations to the President, the Congress, and the public.

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