Bioethics for Breakfast: The Future of Medicaid and the Affordable Care Act: Ethical and Policy Challenges

bioethics-for-breakfastSteve Fitton and Jane Turner, MD, presented at the Bioethics for Breakfast event on February 2, 2017, offering perspective and insight on the topic, “The Future of Medicaid and the Affordable Care Act: Ethical and Policy Challenges.”

We assume that Republicans in Congress will follow through with their promise to repeal the Affordable Care Act. We also assume that there will be some sort of replacement. The expansion of Medicaid coverage represents just about half the increase in newly insured individuals. The proposal that seems to have the greatest likelihood of being enacted would include block-granting Medicaid. From the perspective of the federal government a block grant is a “fixed budget” as opposed to open-ended funding.

Our speakers discussed what this means for those who are dependent upon the Medicaid program for meeting their health care needs. For example, 31 states have expanded their Medicaid programs to 138% of the poverty level, and 95% of those additional costs are supposed to be covered by the federal government. Will those 31 states have those funds included in their block grant but have it denied to the other 19 states? Is it likely that the size of the block grant will be less than what Michigan would otherwise receive under the current funding mechanism? If the size of the grant is reduced, what sort of health care priorities will Medicaid use to determine the allocation of that more limited funding? What do we imagine might be the consequences for hospitals and or long term care facilities if funding is more constrained? These questions and more were addressed by speakers and attendees during the presentations and moderated discussion.

Left to right: Jane Turner, Leonard Fleck, and Steve Fitton pose for a photo after the Bioethics for Breakfast event. Photo courtesy of the Center for Ethics.

Steve Fitton
Steve Fitton is a principal with Health Management Associates. He has extensive expertise in Medicaid financing, federal waivers and reinventing healthcare delivery systems. As Michigan’s Medicaid director, he oversaw a budget of more than $15 billion with programs that served over two million residents. Steve played a key leadership role in the approval and implementation of the Healthy Michigan program, the state’s expansion of Medicaid. Steve led the creation and implementation of several Medicaid programs and initiatives to improve access and quality of care while increasing efficiencies and lowering costs. He earned his bachelor’s degree from Michigan State University.

Jane Turner, MD
Jane Turner is a general pediatrician and professor in the Department of Pediatrics and Human Development. She enjoys all aspects of caring for children and youth and has a special interest in working with children who have chronic health conditions. She has served on the faculty of the College of Human Medicine for more than 20 years as a teacher, clinician, and administrator. Dr. Turner also works for the Michigan Department of Health and Human Services as assistant medical director of the Office of Medical Affairs and chief medical consultant for Children’s Special Health Care Services. She went to medical school at the Oregon Health Sciences University and completed a pediatric residency at Children’s Hospital of Pittsburgh.

About Bioethics for Breakfast:
In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.