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Republican bill calls for accountability and Medicaid and would hand out federal money for the program based on.
How many of your neighbors are on Medicaid and why congressman bill Kasi of Louisiana is the author of the Medicaid accountability and care act.
He joins us now congressman great to see -- That officially the first version of your bill to reform Medicaid died in congress why will this one movie thing.
Well one it's different concepts one -- puts patients first and to a kind of institutes and Medicaid.
Principles that are common and every other major private insurance program.
And so but this is Washington you -- kind of change of paradigm what put patients first two.
Do what the private sector is doing more successfully -- -- trying to introduce it may take a little bit for the game.
Be more specific about how you change the way that Medicaid is paid four or funded to the states.
Yeah Medicaid is actually four different programs if you will pediatric care don't care long term care and blind and disabled.
Very different cost structures -- of those and so if you have a -- lots disabled you get about 50000 dollars per disable.
Whereas if you have a job and you have spend lots of children it's only 15100 there.
There's great these populations -- part you compensate states upon the number they have with each category since the cost basis is so different.
Do you think -- in some way that could encourage the states to enroll more people.
On -- on the -- on Medicaid.
No because the states still have a portion which they are picking up.
And so in this state is not going to make money in the real sense for what he does do is -- -- and give the state a fixed amount.
So no longer is it.
What it is today which is cost plus contract and the state gets paid as much as they bill rather it says hey this is how much you get.
For this population manage -- -- -- private insurance company will putting up your dollars to focus on patient outcomes at the same time you can also focus on your budget.
How is this different from another Republican idea of block grants to the -- something that congressman Paul Ryan has pushed forward.
-- block grants if you will say what is the state received in the past that's what they were received in the future.
It doesn't -- account for the fact the populations grow.
It also doesn't account for the fact in some states have been gaming the system.
Some states have been taking federal tax dollars for the benefit of the state.
Really with -- outcomes associated with that I can give you lots of examples of this.
This -- in the accountability.
That requires a -- to show that what they're doing with federal tax dollars actually improves patient care.
Hey speaking of federal tax dollars before we go about the Medicaid -- expansion.
In Obama care in the Affordable Care Act there's much of a fight going on.
State of Florida one example the governor there signing off on this expansion and then the GOP legislature -- No thank you were not stepping up for this are we entering a period where there's going to be a major quack -- In implementing.
Obama care and people in these states if the states don't sign on to the Medicaid expansion the people in the states will go uninsured.
Well first these people in the states presumably are already unsure -- -- actually.
Many of the people they go on Medicaid after -- Medicaid expansion.
Will be dropping their private insurance and getting on the Medicaid it's predicted as many as 65%.
We'll be dropping their own insurance to go on Medicaid number one number two -- a broken system.
We have not updated substantially since 1965.
No one would fashion Medicaid.
Now as it was back then we would do it differently.
And so I think he kind of -- states are approaching this reflects the fact that it's a broken system.
They're afraid that if they do the expansion you put in place forever a broken system and that's not going to be good for patients not going to be good for taxpayers.
Congressman good to -- you thank you so much congressman bill cast today.
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