Boston University.
J Health Polit Policy Law. 2018 Feb 1;43(1):109-127. doi: 10.1215/03616878-4249861.
Six states that have rejected the Patient Protection and Affordable Care Act's (ACA) Medicaid expansion nonetheless extended the primary care "fee bump," by which the federal government increased Medicaid fees for primary care services up to 100 percent of Medicare fees during 2013-14. We conducted semistructured interviews with leaders in five of these states, as well as in three comparison states, to examine why they would continue a provision of the ACA that moderately expands access at significant state expense while rejecting the expansion and its large federal match, focusing on relevant economic, political, and procedural factors. We found that fee bump extension proposals were more successful where they were dissociated from major national policy debates, actionable with the input of relatively few stakeholder entities, and well aligned with preexisting policy-making structures and decision trends. Republican proposals to cap or reduce federal funding for Medicaid, if enacted, would compel states to contain program costs. In this context, states' established decision-making processes for updating Medicaid fee schedules, which we elucidate in this study, may shape the future of the Medicaid program.
六个拒绝《患者保护与平价医疗法案》（ACA）扩大医疗补助计划的州，尽管如此，仍在 2013-14 年期间延长了初级保健“费用补贴”，即联邦政府将医疗补助计划对初级保健服务的费用提高到 Medicare 费用的 100%。我们对这五个州以及三个比较州的领导人进行了半结构化访谈，以研究他们为什么会继续实施 ACA 的一项规定，该规定适度扩大了获得医疗补助的机会，同时又拒绝了该计划及其大量联邦配套资金，重点关注相关的经济、政治和程序因素。我们发现，在与重大国家政策辩论脱钩、可在相对较少的利益相关者实体的参与下付诸实施、并与现有政策制定结构和决策趋势高度一致的情况下，费用补贴延长提案更容易获得成功。共和党提出的限制或减少医疗补助联邦资金的提案，如果获得通过，将迫使各州控制项目成本。在这种情况下，我们在本研究中阐明的各州更新医疗补助费用表的既定决策程序可能会影响医疗补助计划的未来。
