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Issue brief provides an overview of how a per capita cap financing structure could work, including implications for the federal government, state governments, beneficiaries and health care providers
The House Republican Plan (“A Better Way”) released on June 22, 2016, includes a proposal to convert federal Medicaid financing from an open-ended entitlement to a per capita allotment or a block grant (based on a state choice). This proposal is part of a larger package designed to replace the Affordable Care Act (ACA) and reduce federal spending for health care. Often tied to deficit reduction, proposals to convert Medicaid’s financing structure to a per capita cap or block grant have been proposed before. Such changes represent a fundamental change in the financing structure of the program with major implications for beneficiaries, providers, states and localities. Key things to understand about a per capita cap include the following: how a per capita cap works, key design challenges, and implications of a per capita cap.
The President’s Fiscal Year 2017 (FY17) budget request, which was released on February 9, 2016, included $10.3 billion in total funding for global health programs. This marks the first time in three years that the request for global health is higher than the previous year enacted level, and represents the largest request since FY12. If enacted by Congress, it would represent the highest level of global health funding to date (excluding emergency funding for Ebola provided in FY15).
In response to rising drug costs, some policymakers and presidential candidates, including Republican Donald Trump and Democrats Hillary Clinton and Bernie Sanders, have proposed allowing Medicare to negotiate directly with pharmaceutical companies over the price of prescription drugs, in contrast to the current approach under Medicare Part D drug where private plans do the negotiating.
In this Policy Insight, Jen Kates and Josh Michaud look at the prospects for the future of U.S. global health policy, examining whether long-term bipartisan support may be tested during a time of political transition, and identifying key areas of consensus among policymakers and the public.
The Kaiser Family Foundation has tracked public opinion on global health issues in-depth since 2009. This most recent survey examines views on U.S. spending on health in developing countries and perceptions of barriers and challenges to making progress on the issue. Two-thirds of Americans (65 percent) overall and majorities of Democrats, independents and Republicans alike, say that the United States should play at least a major role in world affairs, including roughly one in five overall (18 percent) who say the U.S. should take the leading role. The survey also finds a general skepticism on the part of the American people when it comes to the effectiveness of global health spending, with seven in ten saying the “bang for the buck” of U.S. spending in this area is only fair or poor, and more than half believing that spending more on global health efforts won’t lead to meaningful progress (a share that has grown since 2012). Although many Americans have concerns about the value of global health spending, six in ten say the U.S. spends too little (26 percent) or about the right amount (34 percent) on global health, and three in ten say it spends too much. Most also recognize benefits to such spending, both for Americans at home as well as for people and communities in developing countries.
While U.S. global health programs have enjoyed bipartisan support in the past, a new survey of the public and findings from interviews with global health and foreign policy experts suggest a growing partisan divide, as the country gears up for the 2016 election.
While global health has enjoyed significant bipartisan support among US policymakers over the past 15 years, the potential for changes in the political landscape in 2016 makes this an opportune time to assess the USG’s position relative to global health needs and funding. With this in mind, the Kaiser Family Foundation’s Global Health Policy Program asked Hart Research Associates and Public Opinion Strategies to solicit the views of specialists in foreign policy and global health.
After Congress provided an unprecedented level of emergency funding for Ebola in FY15 in response to the West African outbreak, beyond regular appropriations for global health programs, FY16 returned to business as usual. There was no additional emergency funding and global health amounts remained essentially flat funding compared to prior years. The FY16 Omnibus Appropriations bill, which was signed into law by the President on December 18, 2015, included an estimated $10.2 billion in funding for global health programs continuing a trend of essentially flat funding since FY10.
As the U.S. enters a Presidential election year and the larger global health and development landscape changes, U.S. global health programs face a key moment of transition. The prior decade saw unprecedented attention to and funding for global health by the U.S. government.
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