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Well-known health economists Thomas W. Grannemann of the Centers for Medicare & Medicaid Services and Mark V. Pauly of the Wharton School of the University of Pennsylvania warn in their newly released book, Reform Medicaid First: Laying the Foundation for National Health Care Reform (AEI Press, June 2009), that the existing Medicaid program will need to be reformed or replaced before any serious health care reform effort can be enacted. Today, significant differences exist among state programs. While states such as Mississippi and Nevada spend as little as $5,000 per poor person annually, New York and Alaska annually spend more than $15,000 per person below the federal poverty level. Large differences in the country’s second-largest health program remain even after correcting for cost-of-living and medical-price differences. This imbalance in Medicaid among states creates an uneven and unstable foundation for any national program to address the needs of uninsured Americans.

In this first important discussion of the serious flaws in the Medicaid program and how best to reform it, Grannemann and Pauly make a strong case for equity, efficiency, and accountability. They explain that controlling the flow of health care dollars is the key to reform and suggest that any new federal health care funds should be directed first toward the lower-income states where the largest numbers of uninsured persons live. The authors propose specific changes in the Medicaid program–from improving provider payment methods to changing the federal medical assistance percentage–to prevent a backlash from overburdened taxpayers that could sink reform efforts in states with many poor people. Responding to the authors’ proposals for reform will be Nina Owcharenko of the Heritage Foundation and Alan Weil of the National Academy for State Health Policy. AEI’s Robert B. Helms will moderate.


Speaker biographies

Thomas W. Grannemann is associate regional administrator for Medicare financial management and fee-for-service operations in the Boston regional office of the Centers for Medicare & Medicaid Services. His research interests include Medicaid financing, hospital costs, long-term care, physician productivity, provider payment methods, and workers’ compensation. Previously, Mr. Grannemann was a senior economist at Mathematica Policy Research, where his work involved design and analysis of major national Medicare and Medicaid demonstration projects. He has also served as chief of the Bureau of Economic Analysis and Rate Setting Policy with the State of New Hampshire Office of Medicaid Business and Policy. For several years, Mr. Grannemann taught health economics, health policy, and public finance at the University of Colorado’s Graduate School of Public Affairs and managed his own research and consulting business, Andover Economic Evaluation. He is the author of numerous publications on Medicaid, Medicare, and health care reform topics.

Robert B. Helms has served as a member of the Medicaid Commission as well as assistant secretary for planning and evaluation and deputy assistant secretary for health policy at the U.S. Department of Health and Human Services. An economist by training, he has written and lectured extensively on health policy and health economics, including the history of Medicare, the tax treatment of health insurance, and compared international health systems. He currently participates in the Health Policy Consensus Group, an informal task force that is developing consumer-driven health reforms. He is the author or editor of several AEI books on health policy, including Medicare in the Twenty-first Century: Seeking Fair and Efficient Reform and Competitive Strategies in the Pharmaceutical Industry.

Nina Owcharenko is a senior policy analyst for health care at the Heritage Foundation’s Center for Health Policy Studies. In this position, Ms. Owcharenko (pronounced oh-CHAH-renko) researches and writes on a variety of health care policy issues, including the uninsured, Medicaid, and prescription drugs. She has presented before numerous national, state, and professional conferences and has been published in noted publications, such as Health Affairs. She has also been a guest on dozens of radio and television programs. In 2008, Ms. Owcharenko’s work on health care issues, especially on the State Children’s Health Insurance Program, earned her Heritage’s prestigious Drs. W. Glenn and Rita Ricardo Campbell Award. The award is given to the employee who has delivered “an outstanding contribution to the analysis and promotion of a Free Society.” Ms. Owcharenko served for nearly a decade on Capitol Hill, focusing on health care issues. Before coming to Heritage in 2001, she served as the legislative director for Representative Jim DeMint (R-S.C.) and Representative Sue Myrick (R-N.C.). She started her Hill career working for Senator Jesse Helms (R-N.C.).

Mark V. Pauly is Bendheim Professor in the Department of Health Care Management; Professor of Health Care Management, Insurance and Risk Management, and Business and Public Policy at the Wharton School; and Professor of Economics in the School of Arts and Sciences at the University of Pennsylvania. He is also an adjunct scholar at AEI. Mr. Pauly is an active member of the Institute of Medicine and serves on the national advisory committees for the National Institutes of Health’s National Center for Research Resources, the National Academy of Sciences’ Committee to Study the Veterinary Workforce, and the National Vaccine Advisory Commission. He is a co-editor-in-chief of the International Journal of Health Care Finance and Economics and an associate editor of the Journal of Risk and Uncertainty. A former commissioner on the Physician Payment Review Commission, Mr. Pauly has also served on the advisory committee of the Agency for Health Care Research and Quality and the Medicare Technical Advisory Panel.

Alan Weil has been the executive director of the National Academy for State Health Policy since September 2004. Previously, Mr. Weil served as director of the Urban Institute’s Assessing the New Federalism, one of the largest privately funded social policy research projects ever undertaken in the United States. He previously held a cabinet position as executive director of the Colorado Department of Health Care Policy and Financing, was health policy adviser to Colorado governor Roy Romer, and was assistant general counsel in the Massachusetts Department of Medical Security.

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