Monday, July 20, 2009

Health Care Reform Legislation - what's in it for coordinated transportation?

While there are many significant issues being debated and amended in Congressional committees concerning health care reform, most of these proposed overhauls are not likely to have a direct effect on the provision of transportation services.

The largest area of transportation interest is the proposed expansion of Medicaid coverage. In its current form, the House version of health care reform (H.R. 3200) would expand the pool of Medicaid-eligible persons to almost all people at or below 133 percent of poverty, starting in 2013. As drafted in the House, there would be a 100 percent federal share for all Medicaid expenses incurred for persons added to the Medicaid population under this bill. It's not yet clear how this expansion of Medicaid would affect the provision of transportation, or the matching rates that would be used. Those questions may become clearer after the House Energy and Commerce committee completes its markup this week.

The Congressional Budget Office has estimated this expansion of Medicaid would come with a $438 billion price tag to the federal budget between now and FY 2019.

Elsewhere in the draft House bill, there is an authorization for an $89 billion "public health investment fund," which would be used to support a number of activities, including a $39 billion expansion of the community health centers network over the next ten years. Although not treated as "mandatory" spending, this new trust fund, and its expenses, would be "off budget" when deficit calculations and budget balancing goals are addressed by Congress.

The health care debate remains very fluid. Two of the three House committees with jurisdiction - Ways & Means and Education & Labor - completed their work on portions of the House bill on July 17. The third - Energy & Commerce - is marking up its sections of the bill during the week of July 20.

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