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On June 28, the U.S. Supreme Court ruled that states cannot be compelled to participate in the Affordable Care Act’s Medicaid expansion, thus giving each state the ability to decide if and how to expand its Medicaid program. At an AEI event on Wednesday, health policy experts joined state and federal legislators to discuss states’ Medicaid policy options.

Secretary Gary Alexander of the Pennsylvania Department of Public Welfare highlighted the success of the Rhode Island Medicaid waiver. The waiver’s spending cap and its flexibility for state delivery system reforms, he explained, have made it highly effective in both controlling Medicaid costs and improving access to services. Rep. Bill Cassidy (R-La.) outlined his plan for Medicaid reform — the Medicaid Accountability and Care Act — which would, unlike the current system, allot federal Medicaid funds according to the number of enrollees per state. Christie Herrera of the Foundation for Government Accountability discussed the success of Florida’s 2005 market-based Medicaid reform, which could save the state $1 billion if implemented statewide.

Florida and Rhode Island’s successful policies —as well as the features of Cassidy’s proposal — should provide a model of reform for other states as they decide how to improve their programs for low-income Americans.
–Catherine Griffin

Event Description
Although the U.S. Supreme Court upheld the overall constitutionality of the Affordable Care Act (ACA) on June 28, it ruled that states cannot be compelled to participate in the law’s expansion of Medicaid if they wish to retain only the pre-ACA version of the program in their particular state.

How will different states respond to this choice as Medicaid begins to increase its income eligibility levels, revise its mandatory benefits and boost federal funding for the program? How will Medicaid programs be financed and what are the best methods for improving the quality of care Medicaid provides to low-income Americans?

A panel will examine the latest Medicaid policy options across the legislative, administrative and judicial fronts. Secretary Gary Alexander of Pennsylvania’s Department of Public Welfare — the architect of the landmark Rhode Island Medicaid waiver — will discuss state-based Medicaid reform through capped entitlements or block grants. Christie Herrera of the Foundation for Government Accountability will review Florida’s pilot program for Medicaid reform and Florida’s request to expand it statewide. James Blumstein of Vanderbilt Law School will explain the legal rationale and future implications of the Supreme Court’s recent finding that the ACA’s mandatory expansion of Medicaid in all states was unconstitutionally coercive. Rep. Bill Cassidy will describe the key elements of his recently introduced Medicaid Accountability and Care Act, which builds upon a per capita federal block grant to states and adds incentives to provide better patient care.


 Full video will be posted within 24 hours.


10:15 AM

10:30 AM
Gary Alexander, Pennsylvania Department of Public Welfare
James Blumstein, Vanderbilt Law School
Bill Cassidy, U.S. House of Representatives (R-La.)
Christie Herrera, Foundation for Government Accountability

Thomas P. Miller, AEI

12:00 PM

Event Contact Information

For more information, please contact Catherine Griffin at [email protected], 202.862.5920.

Media Contact Information

For media inquiries, please contact Véronique Rodman at [email protected], 202.862.4871.


Speaker Biographies

Gary Alexander is widely recognized as a health care and Medicaid expert, welfare reformer and management specialist. Appointed by Pennsylvania Governor Tom Corbett as secretary of public welfare for Pennsylvania in January 2011, Alexander is responsible for overall operations, management and policy development of the largest state-level health and human services agency in the nation. Before this position, Alexander served in a similar capacity as the Rhode Island secretary of health and human services (HHS) and human services director from 2006 to 2011. He also served in other key HHS positions such as assistant to the Rhode Island human services director and HHS budget analyst for the Massachusetts Senate Committee on Ways and Means. Alexander is the architect and author of the 2009 Rhode Island Global Medicaid Waiver that created a new federal-state agreement with unprecedented flexibility to redesign the Medicaid system. By changing the welfare culture that favors unlimited spending, introducing accountability into Medicaid and improving quality, Alexander’s initiative has been cited as a model of entitlement reform — particularly Medicaid reform —by various experts and publications, including The Wall Street Journal.

James Blumstein ranks among the nation’s most prominent scholars of health law, law and medicine and voting rights. As the director of Vanderbilt University’s Health Policy Center, Blumstein has served as the principal investigator on numerous grants concerning managed care, hospital management and medical malpractice. Blumstein has been the Olin Visiting Professor at the University of Pennsylvania Law School, an adjunct professor at Dartmouth Medical School, and a visiting professor at Duke Law School and at Duke’s Institute of Policy Sciences and Public Affairs. He has served as Tennessee Governor Phil Bredesen’s counsel on TennCare reform and has participated actively in a number of U.S. Supreme Court cases, having arguied three. A dedicated teacher, Blumstein has received Vanderbilt Law School’student-sponsored Hartman Teaching Award. He joined Vanderbilt’s law faculty in 1970.

Bill Cassidy has served as the U.S. representative for Lousiaina’s sixth congressional district since 2009. As an associate professor of medicine at Louisiana State University, Cassidy has provided care for uninsured patients and taught doctors in training at Earl K. Long Hospital in Baton Rouge for the last 20 years. He co-founded the Greater Baton Rouge Community Clinic, which provides free dental and health care to the working uninsured. Cassidy also created a private-public partnership to vaccinate 36,000 greater Baton Rouge-area children against hepatitis B at no cost to the schools or parents. Before his election to the U.S. House of Representatives, Cassidy served in the Louisiana State Senate. In the House, he serves on the Energy and Commerce Committee and on its Subcommittees on Health; Commerce, Manufacturing and Trade; and Environment and the Economy. He serves as an assistant whip for the House Republican Conference. His legislative focus is health care and energy.

Christie Herrera is vice president of policy at the Foundation for Government Accountability (FGA), a Florida-based public policy research and advocacy organization. Most recently, Herrera served as director of the Health and Human Services Task Force at the American Legislative Exchange Council (ALEC), a nationwide, nonpartisan association of state legislators. During her time at ALEC, 38 states enacted model legislation drafted by the Human Services Task Force. Herrera has also been a key figure in galvanizing state pushback against the harmful effects of the federal health law. A bipartisan collection of 14 states have enacted ALEC’s Health Care Freedom Act, a measure designed to protect patients’ rights and block a government requirement to purchase health insurance. Christie has testified before the U.S. Congress and legislatures in 13 states and she has been a featured speaker to legislative caucuses, nonprofit organizations and business groups across the country. Her policy work has been covered by The New York Times, The Washington Post, The Wall Street Journal, The Economist, Politico, and Fox News Channel, among other media outlets.

Thomas P. Miller is a resident fellow at AEI, where he focuses on health policy with a particular emphasis on information transparency, health insurance regulation and consumer-driven health care. He was a member of the National Advisory Council for the Agency for Healthcare Research and Quality from 2007 to 2009. Before joining AEI, Miller served for three years as a senior health economist for the Joint Economic Committee, where he organized a series of hearings focusing on promising reforms in private health care markets. He has also been director of health policy studies at the Cato Institute and director of economic policy studies at the Competitive Enterprise Institute. Miller’s writing has appeared in publications such as Health Affairs, The Wall Street Journal, The New York Times, The Washington Post, the Los Angeles Times, Reader’s Digest, National Review and Before moving to Washington, D.C., to work on public policy, he was a trial attorney, journalist and radio broadcaster.


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