The impact on overall household cost accrual should not be overlooked as the implications on already financially disenfranchised groups would impose compounded disadvantage. This 2018 survey conducted by Carescout covered 440 regions and included 15,500 individual surveys which estimate the median cost of adult day care at $18,720. median cost of assisted living at $48,000, and the median cost of nursing home care at $89,297 annually (https://www.genworth.com/aging-and-you/finances/cost-of-care.html) further contextualizing the overwhelming burden of absorbing long term health cost in the absence of public funding

Effectively targeting exploration on the topic of not-for-profit responsiveness may help mediate the disparate costs associated with home health care. The impact of new technologies should be considered when assessing the ability of these organizations to respond. Saxton, Guo, & Brown (2007) found that limitations in design and content availability profoundly affected the responsiveness of non-profit organizations. These structural barriers should be evaluated by providers to enhance financial sustainability.

Link: https://www.jstor.org/stable/20447669?seq=1#metadata_info_tab_contents

What we may find through the introduction of conditional subsidies is the impact of cash allowances for mitigating overall household costs in a households with lower socioeconomic statuses. However, varying configurations in the implementation of cash for care models have been shaped by timing, specific regulations and policy context of reforms in European countries currently utilizing these approaches (Roit & Bihan, 2010). This informs perspectives on the generalizability of subsidization outcomes.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000929/

The subsidisation of informal care has brought with it ongoing debate on both the efficacy and impact for individuals with varying needs of ADL support. In a study conducted by Kim and Lim (2012) findings suggest that institutional care is most cost-effective for individuals partially-dependent on support for several ADL's in that it led to reduction of informal care and medical expenditures whereas cost benefits for home care were higher among individuals that were completely dependent on ADL support through reduced spending on institutional support. Overall a shift from formal care to informal home care seems to be placated here as a financial target for sustainability.

Link: http://www.columbia.edu/~hk2405/ltc_for_publication_v04.pdf

In the examples provided Matthew Eyles provides a thoughtful consideration of the possible ways enacting these provisions could work to the benefit of patients. The network changes applauded are largely person centered and in the aim of service delivery and access.

Operating loosely from the coordinated specialty care approach the ability of managed care plans to secure services for patients across their diverse needs is a central to the quality of public health and underscores the impact that removing such ability would have on the public at large.

This statement seems to hint at the likelihood that proposals would undermine the efficacy of medicaid to secure services and maintain financial viability over time of implementation. As mentioned by AEH (Americas Essential Hospitals) most organization are operating on little to no profit margin: https://essentialhospitals.org/general/statement-on-house-reconciliation-legislation/ which means that cuts such as these could result in reductions to staff and hospital services overall.

The erosion of medicaid program coverage is what we can see in the horizon under these shifts. Reductions in standards of care, quality assurance and government accountability for public health will inevitable lead to the negligence of service availability for low income and high risk populations. The benefit of these changes will be seen mainly among private interest sectors that have customarily re allocated funds from safety net programs into state budget spending.

Reducing availability of funds for individuals needing treatment adds overwhelming weight to the public health crisis and early intervention leads to reduced health costs and improved overall outcomes. For minority populations these changes could present compounded risk due to already existing disparities in treatment : https://www.cancer.gov/about-nci/legislative/hearings/2000-ethnic-minority-disparities-cancer-treatment.pdf as black americans already face higher rates of overall incidence of cancer and higher rates of death than their white counterparts.

The implications of lesser coverage would be vast particularly for children insured through medicaid during their time of diagnosis. These individuals may face additional risk to their healthcare assess due to changes in regulatory protections currently being proposed (i.e. protections for pre-existing conditions).

Joshua Cohens explains the Trumps administrations approach at eroding foundations built within the ACA https://www.forbes.com/sites/joshuacohen/2018/10/08/possible-removal-of-pre-existing-conditions-protections/#edf0450e8aef

Neomi Rao, newly confirmed administrator of White House Information and Regulatory affairs attempts here to renounce personal ownership of deregulation efforts instead framing the current move as the continuation of an existing motion present in previous leadership. She attempts to insure the rational saliency of deregulation through this logic of a theoretical continuum.