JHPPL Workshop on Medicaid Fiscal and Governance Issues: Objectives and Themes

At a November 2012 workshop, state health policy officials, other Medicaid and insurance exchange practitioners, and health policy researchers discussed issues surrounding the implementation and sustainability of Medicaid expansion and insurance exchange coordination under the Patient Protection and Affordable Care Act (PPACA). Foremost were concerns about (1) intergovernmental relations (states experiencing uncertain information, lack of coordination among federal agencies, and limited resources to take on new responsibilities under the PPACA), and (2) policy design (new issues such as Medicaid exchange coordination on top of preexisting Medicaid challenges). JHPPL has proposed the creation of a research network to develop policy options and share strategies and best practices. JHPPL would like to thank the Blue Shield of California Foundation for funding this workshop and series of articles. Journal of Health Politics, Policy and Law, Vol. 38, No. 4, August 2013 DOI 10.1215/03616878-2208621 2013 by Duke University Press In November 2012, the Journal of Health Politics, Policy and Law convened a workshop on Medicaid fiscal and governance issues. Sponsored by Blue Shield of California Foundation, with additional support from the Center for Health Administration Studies at the University of Chicago, and the Robert Wood Johnson Foundation, the workshop brought together senior state health policy officials, other practitioners involved in Medicaid policy and the development of state exchanges, and researchers from academia and think tanks. The workshop had several goals: (1) to provide an opportunity for peer learning among state Medicaid leaders, policy practitioners, and policy researchers with respect to the implementation and sustainability of Medicaid expansion-related policies; (2) to discuss and document opportunities and challenges for states as they implement the Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA); (3) to explore how a JHPPL-led practitioner-scholar network could add value; and (4) to identify strategies for disseminating information and findings to states and networks of policy makers and analysts. To set the context for the discussion, several researchers presented on key issues related to Medicaid and the implementation of the PPACA. John Holahan of the Urban Institute began the workshop by presenting recent research estimating the effects of the PPACA on state Medicaid costs, Medicaid enrollment, and remaining number of uninsured by state. He concluded that although there was variability by state and region, overall the Medicaid expansions provided significant benefits for states relative to their investments. Katherine Swartz, a Harvard health economist, shared her research on the long-term sustainability of Medicaid given broad socioeconomic, demographic, and health care trends. She concluded that Medicaid would require major changes over time. Sara Rosenbaum of the George Washington University laid out a series of opportunities for state flexibility in program design related to implementing the PPACA. Finally, Larry Jacobs, a political scientist at University of Minnesota, shared early results from a new project analyzing the key factors associated with PPACA implementation trajectories. He found that state administrative capacity and previous policy experience were more predictive of implementation success than was the partisan composition of state political leadership. Each presentation was followed by commentary and reflections from a senior state health official, who shared his or her perspectives on the issues identified. Several themes emerged from the reactors and discussion following the presentations: 842 Journal of Health Politics, Policy and Law