Medicaid plays an important role in the health care system of the US, now offering coverage of health insurance to over one in five Americans. However, reforming major federal entitlement programs such as Medicaid is always associated with some policy issues or challenges. According to Conover (2017), one of the major policy challenges of Medicaid reform, that is, Medicaid expansion is the high costs associated with it. This is because Medicaid expansion fuels excess federal spending because of its matching rate that is open-ended. As such, leaving other factors constant, an analysis at UC Berkeley by Thad Kousser indicated that shifting from the lowest to the highest spending of the federal matching rates raises the discretionary expenditures of Medicaid by 22 percent (Conover, 2017). Thus, from the perspective of taxpayer or social, this increase in costs has created severe equity and efficiency problems.
Advantages and Disadvantages of Incremental Policy Change
Incremental policy changes, especially in health care reform have both advantages and disadvantages. On one hand, supporters of incremental health reform policy accentuate that because the evolution of the U.S. health system is constantly changing and decentralized as well, continuous improvement is vital (Butter, 2017). Therefore, the complex system of health care will work better over time if driven by decision-making and innovations in care delivery and healthcare organizations (Butter, 2017). These innovations to keep up with the constant evolution are possible through incremental policy. Second, the innovation and decentralization in government are essential, as there needs to be constant experimentation in the financial assistance and rules in the government frameworks within which the healthcare operates (Butter, 2017). Therefore, incremental policy enables states to explore innovative approaches of reaching the goals of healthcare reforms, provided they conform to the financial safeguard for household and national coverage.
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On the other hand, McCanne (2013) argue that incremental policy change on federal entitlement program such as Medicaid can also contain serious disadvantages. First, the system of health care being a complex one, incremental policy change, even the small changes if not considered carefully, can have side effects that are unexpected which are serious and costly. Second, these policy changes in Medicaid may not be modest. This is because they can revolutionize the system of health in the next generations, rechanneling a lot of billion dollars yearly and changing the very nature of the system of health care in the U.S.
Similarly, there are also advantages and disadvantages associated with pursuing policy change that is radical or more far-reaching, whether both political spectrum sides endorses the idea. According to Butter (2017), one disadvantage with pursuing such policy change is that it can be pushed through a party-line vote that is narrow, thus ruling out later legislative amendments/corrections by the opposition. As such, this can later make it harder to fix the inevitable errors in the future (Butter, 2017). Second, it can also result in pursuing a policy change that might be to the disadvantage of other groups of people. This is because the policy may be in line with fulfilling the political interest of the majority members from one side of the political spectrum. However, it will be to the advantage of the public if both sides of the political spectrum pursue a radical policy change in the healthcare reforms without prioritizing their political interest. This is especially true if the reform brings with it many health benefits such as controlling cost while improving the quality.
References
Butter, S. (2017, February 1). Replacing Obamacare needs to be done incrementally. Brookings . Retrieved October 8, 2018, from https://www.brookings.edu/opinions/replacing-obamacare-needs-to-be-done-incrementally/
Conover, C. (2017, June 16). Fixing the 3 Biggest Flaws in Obamacare's Medicaid Expansion: Part 2. Forbes . Retrieved October 8, 2018 from https://www.forbes.com/sites/theapothecary/2017/06/16/fixing-the-3-biggest-flaws-in-obamacares-medicaid-expansion-part-2/#10f84b3f3c12
McCanne, D. (2013). Why incremental reforms will not solve the health care crisis. The Journal of the American Board of Family Practice, 16(3), 257-261.
