1. Medicaid & Deficit Reduction Tony McCann

2. Aggravating Factors - Revenues Alternative Minimum Tax Taxes as a % of GDP 1/20/2016Page 2

3. Aggravating Factors – Health Spending Revision of Sustainable Growth Rate Affordable Care Act –CLASS Act (+$81 Billion) –Medicare HI tax increase –Medicare “Provider productivity” tax increase –Tax on High Cost Insurance 1/20/2016Page 3

4. Medicaid Four separate programs –Acute care –Long term care – aged –Mental health services –Developmental disability Direct services Education 1/20/2016Page 4

5. Medicaid Managed Care –Initial success at price negotiations –No “management” of care –Creation of powerful lobbies in state capitals 1/20/2016Page 5