The unreported soft underbelly of the American non-system of care is the increasing medicaid population which when added to the uninsured is about 120,000,000 people. (50,000,000 uninsured, 68,000,000 on medicaid with some overlap) Astounding numbers when you consider the budgetary difficulties facing state governments and consequently Medicaid.
Approximately 68 million Americans were enrolled in Medicaid at some point during 2010, when the program spent $406 billion on acute and long-term care services for its beneficiaries.1 Another 16 million people are slated to gain Medicaid eligibility through the Patient Protection and Affordable Care Act (ACA), which would make the federal–state program responsible for financing services for more than one in four Americans. Enacted in 1965 as an afterthought to Medicare, Medicaid has become a vast public enterprise that underscores the limits of the private insurance market even as it squeezes state budgets already stretched by the recession. These realities, along with the fact that an increasingly conservative electorate has given Republicans control of the U.S. House of Representatives, raise a fundamental question for policymakers: What level of support should government provide to people who can’t afford private insurance and are not offered employer-sponsored coverage?
Medicaid serves the nation’s neediest and sickest patients: low-income children and mothers, the elderly, people with permanent disabilities and the poorest of adults. Despite periodic calls to privatize Medicaid, in reality it serves a population that private health insurance was not designed to serve and probably does not want to cover. What private insurance system is willing to pay for long-term care for low-income elderly or disabled people, whether through home- and community-based care or in nursing homes? What private firm is eager to cover families and children who are typically too poor to afford insurance premiums?
On one hand, House Republicans are supporting a budget proposal from Budget Committee Chairman Paul Ryan to cut Medicaid expenditures by $1.4 trillion (yes, trillion with a “t”) over the next decade and to block grant the program. (It is not clear, but it looks like the plan would also terminate the Children’s Health Insurance Program.) His overall budget plan would cut about $6 trillion in budget expenditures, although most of those savings would be used to extend tax cuts for wealthy Americans and cut taxes for many other groups.
Medicynical Note: It’s hard to accept our current budget/health care situation and not look at other industrialized nations where nearly all citizens have health care coverage, at , much lower cost.