The NEJM reviews the limitations of Medicaid, which is about to get worse whether or not there is agreement on debt extension:
Since Medicaid was enacted in 1965, its coverage guarantee for millions of the poorest Americans has faced a substantial vacuum in actual access to health care. Multiple factors contribute to this problem: severe shortages of physicians and hospitals in many low-income inner-city and rural communities; low rates of participation in Medicaid among available providers, owing to low payment rates; state administrative practices that drive providers away; and the economic, clinical, educational, and cultural characteristics of Medicaid beneficiaries. Where they are operating, federal programs such as community health centers, federally funded family planning agencies, the National Health Service Corps, local public health agencies, and public and children’s hospitals help to mitigate the situation. But thousands of U.S. communities lack such programs, and even where they do exist, they don’t address the specialized long-term care needs of beneficiaries with severe disabilities.
Medicynical note: This in the “best” and most expensive non-system of healthcare in the world.