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17 Georgetown Journal on Poverty Law Policy 405 (2010)


This article examines the Bush Administration's attempts to transform certain supplemental payments, most notably Medicaid’s Disproportionate Share Hospital (DSH) program, into a means of subsidizing private health coverage for Medicaid expansion populations. Greater private market involvement in the state disbursement of supplemental payments such as DSH makes it more difficult to fulfill Medicaid’s original goals. It reduces the overall funds available specifically for care, provides beneficiaries with leaner benefit plans than those offered by the public system, and hinders beneficiaries from obtaining and retaining care. As such, it increases waste and inefficiency, rather than reducing them. At the same time, rather than improving access to overall medical care and provider choice, it instead prioritizes choice among private insurance products. This not only subverts the original goals of Medicaid, but also suggests a key shift in our conceptualization of what it means to access health care in the United States.