Effects of Medicare and Medicaid

Dear Colleagues,

Federal health insurance coverage options Medicare and Medicaid provide Americans with access to affordable healthcare coverage to live happy, healthy, and productive lives. While Medicare offers coverage to 64 million individuals aged 65 years or over for their hospital stays, outpatient services, prescription drugs, and post-acute care services, Medicaid covers more than 84 million eligible children, pregnant women, low-income adults, and people living with disabilities. However, the federal government is facing a fiscal crisis with impending insolvency of the Medicare Trust Fund which was exacerbated by the COVID-19 public health crisis. Addressing the spending growth of the Medicare Trust Fund and healthcare affordability will require improving the efficiency of healthcare delivery, achieved by reducing payment rates and decreasing service volume (i.e., overuse or redundant care) while maintaining or improving quality. The participation in the Shared Savings Program, the largest accountable care organization (ACO) initiative in Medicare, has been stalled since 2018. There is a clear consensus on the goals of payment reforms in the Medicare program to address the financial sustainability of the program. The COVID-19 pandemic has profoundly impacted the Medicaid program in terms of enrollment and policy. The program is now facing the challenge of moving towards a new normal operation from unwinding the public health emergency (PHE) status, which ended in January 2022. More than 75% of Medicaid beneficiaries are now enrolled into The Medicaid Managed Care Organization (MCO). To inform policymakers, payers, and consumers, we need evidence on how to introduce innovations in the delivery and payment systems in both programs with a goal to improve health while addressing the expenditure growth of the programs. Papers addressing these topics are invited in this Special Issue, especially those combining a high academic standard with a focus on delivery and payment innovations for improving the health and wellbeing of millions of Americans.

Dr. Rashmita Basu
Guest Editor

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• medicare
• medicaid
• medicare advantage
• accountable care organization
• post-acute care
• medicare payment for post-acute care
• delivery and payment policies