Is there a point where fiscal constraints trump equity or the likelihood of improved health outcomes when designing a public insurance program?

1.When designing CHIP, policymakers chose to follow the private insurance model instead of the Medicaid model. Although states have the choice to create a generous Medicaid expansion program for their CHIP beneficiaries, they also have the choice to implement a more limited insurance program with fewer protections. Similar choices were made when the DRA options were created for Medicaid. These decisions raise essential questions about the role of government in public insurance programs. Does the government (federal or state) have a responsibility to provide additional benefits and protection to its low-income residents? Or, is the government satisfying any responsibility it has by providing insurance coverage that is equivalent to major private insurance plans? What if the standard for private insurance plans becomes lower—does that change your analysis? Is it fair for low-income individuals to receive more comprehensive health insurance coverage than other individuals? Is there a point where fiscal constraints trump equity or the likelihood of improved health outcomes when designing a public insurance program?

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