By NextBestFitPhase 0: Preparation · Step 0.1
Set each state's contribution
Months −16 to 0 · HHS / Treasury / statesDiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | States currently pay $335.0B for Medicaid. Under a national program that money keeps flowing as a maintenance-of-effort (MOE) payment, so states pay what they paid before while the national program takes over the care. | ||
| Canada | Federal Canada Health Transfer conditional on provinces meeting Canada Health Act criteria; the federal share fell from 50% to about 22–25%. | Recurring federal–provincial fights over funding. | Intergovernmental funding formulas need automatic indexing or they become annual battles. |
| Spain | Health care devolved to 17 autonomous communities, funded by general tax transfers (completed 2002). | Universal coverage with regional variation in waits and benefits. | Devolution allows local control at the cost of uniformity. |
Canada
- What they did
- Federal Canada Health Transfer conditional on provinces meeting Canada Health Act criteria; the federal share fell from 50% to about 22–25%.
- What happened
- Recurring federal–provincial fights over funding.
- Lesson for this plan
- Intergovernmental funding formulas need automatic indexing or they become annual battles.
Spain
- What they did
- Health care devolved to 17 autonomous communities, funded by general tax transfers (completed 2002).
- What happened
- Universal coverage with regional variation in waits and benefits.
- Lesson for this plan
- Devolution allows local control at the cost of uniformity.
More precedent
- Medicare Part D 'clawback' (2006): states pay the federal government for drug costs of dual eligibles.