February 2009 Article

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Healthcare Reform Under Our Noses?
by Ken Yale, DDS, JD 
The $819 billion economic stimulus package is making its way through the Congressional process, with the House of Representatives passing, and the Senate now considering, separate versions of the legislation. There is $87 billion in the legislation for Medicaid, to pay for the increasing number of persons who are unemployed and qualify for this program designed for persons with low or no income. But this is no ordinary Medicaid relief package. Unlike the economic downturn of 2003, when Medicaid funding was used to replace the deficit caused by more people qualifying for Medicaid, the current legislation actually changes the eligibility requirements to allow more persons to qualify. 
Details of the House version have novel expansions of Medicaid to cover unemployed persons who might not otherwise be eligible. The bill allows unemployed persons to qualify temporarily for Medicaid, and it pays for 65% of unemployed persons' "COBRA" continuing health insurance coverage for one year. It also allows persons over 55 years of age to keep their COBRA coverage until they find a new job or qualify for Medicare. This has elements similar to the Obama campaign health care reform proposal,  which called for expansion of Medicaid to cover low-income adults, and also included a subsidy for health insurance premiums. Is this the Obama health care reform proposal taking shape under our noses?

To be sure, the eligibility for Medicaid is only temporary. Given the state of the economy, it is important to stimulate economic activity and help people who have lost their jobs. But it is unprecedented as it expands a government program without normal Congressional deliberation, and establishes the infrastructure and precedent for expanding Medicaid to persons who are not low income or disabled and would not normally be eligible. The actual impact of this approach remains to be seen, and it will be very interesting to watch this experiment in public policy. Stay tuned.


About the Author
Ken Yale, DDS, JD, has been a senior executive for more than 15 years in entrepreneurial and large publicly traded health care companies. He has extensive experience in business development, innovation process management, new market creation, and new product development. He is credited with a number of innovations, including setting up the first Provider Service Network, establishing the Medicare Subvention program which became TRICARE-for-Life, and creating the Collaborative Medical Home model of care coordination. In addition to his entrepreneurial work, Dr. Yale worked in the US Senate and the White House, where he became an expert in Medicare and Medicaid. You may read more of his observations at  http://www.medicaidfrontpage.com.


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