THIS IS ONLY AN INTERPRETATION, FIVE SENTENCES AND A QUESTION IS ALL I NEED. TELL ME YOUR THOUGHTS
A mandate is a statute or ruling that requires an expenditure from a government. The federal government often absorbs some or all of the financial burden of mandates on states, but it does not always do so (Mikesell, 2014). The Unfunded Mandate Reform Act of 1995 was passed to try to curtail costs imposed on state and local governments because of federal mandates. This act, however, only stipulates that the costs associated with mandates are clear, not that mandates must be funded on a national level (Mikesell, 2014). Conflicts can occur when mandates impose financial requirements on states that do not have the means to meet them.
Mandates are meant to address issues that affect people on a national level, not those issues that only affect small portions of localized populations (Gilette, 2012). In the U.S., state and local governments enjoy a certain amount of autonomy concerning economic policies, but still must follow laws put forth by the federal government (Sorens, 2011).
Medicaid is a healthcare program in the United States that is funded by federal and state governments to insure low income and disadvantaged people who meet certain requirements. It is a federal mandate, with the federal government paying anywhere from 25-50%, based on per capita income of states, and states paying the rest (Financing & reimbursement, n.d.). This means state budgets need to come up with a large amount of money to help fund the insurance program.
The federal government requires states to provide 16 benefits to Medicaid recipients (such as inpatient and outpatient hospital visits, home healthcare, physician checkups, etc.), but the states are given flexibility with additional benefits they want to offer their Medicaid recipients (Medicaid spending in Washington, n.d.). This flexibility is a way that states help control their budgets. When budget cuts are needed or revenue is reduced, states will often cut some of the “extra” benefits that are offered above and beyond the 16 required by the federal government (Antonisse, Hinton, Rudowitz, Gifford, & McMahon, 2017). A way for states to increase revenue to help provide for state budgets is to increase taxes. Washington has proposed a new capital gains tax and to expand the sales tax base to help offset increased costs in state finances(Antonisse et al., 2017). Medicaid costs Washington nearly $11 billion (Total Medicaid spending, 2016). This accounts for 16.5% of Washtington’s overall budget (Antonisse et al., 2017).
Medicaid is estimated to have cost the United States $555.5 billion in 2016 (Total Medicaid spending, 2016). Even though Medicaid is an expensive program, and arguably could be restructured to be more efficient, it is important for citizens’ needs to be met. Citizens are the main stakeholder of governments, and doing things that meet their best interest is a duty of government. Despite the numbers seeming staggering, and many states facing budget issues, state governors are proposing more enhancements to Medicaid. State governors are proposing provider rate increases or benefit enhancements more than those that are proposing rate cuts or benefit restrictions (Antonisse et al., 2017). I think because of the health benefits it provides to those who could otherwise not afford healthcare, Medicaid is a positive mandate. It does impose a financial burden on state governments, but it is not the biggest financial burden put on states. In Washington for example, where Medicaid accounted for 16.5% of the state’s overall budget, education is 37.1% (Washington state budget and finances, 2016).
Antonisse, L., Hinton, E., Rudtowitz, R., Gifford, K., McMahon, N. (2017). Governor’s proposed budgets for FY 2018: Focus on Medicaid and other health priorities. Retrieved from http://files.kff.org/attachment/Issue-Brief-Governors-Proposed-Budgets-for-FY-2018-Focus-on-Medicaid-and-Other-Health-Priorities
Financing & Reimbursement. (n.d.). Retrieved from https://www.medicaid.gov/medicaid/financing-and-reimbursement/index.html
Gillette, C. P. (2012). Fiscal federalism as a constraint on states. Harvard Journal of Law & Public Policy, 35(1), 101–114.
Medicaid spending in Washington. (n.d.). Retrieved from https://ballotpedia.org/Medicaid_spending_in_Washington
Mikesell, J. L. (2014). Fiscal administration: Analysis and applications for the public sector (9th ed.). Boston, MA: Wadsworth.
Sorens, J. (2011). The institutions of fiscal federalism. Publius: The Journal of Federalism, 41(2), 207–231.
Total Medicaid spending. (2016). Retrieved from http://www.kff.org/medicaid/state-indicator/total-medicaid-spending/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Washington state budget and finances. (2016). Retrieved from https://ballotpedia.org/Washington_state_budget_and_finances