How we became a Medicaid nation
More than 1 in 5 in U.S. rely on it for health care
When high levels of lead were discovered in the public water system in Flint, Mich., in 2015, Medicaid stepped in to help thousands of children get tested for poisoning and receive care.
When disabled children need to get to doctors’ appointments — either across town or hundreds of miles away — Medicaid pays for their transportation.
When middle-class older Americans deplete their savings to pay for costly nursing home care, Medicaid offers coverage.
The United States has become a Medicaid nation.
Although it started as a plan to cover only the poor, Medicaid now touches tens of millions of Americans who live above the poverty line. The program serves as a backstop for America’s scattershot health care system, and as Republicans learned this year in their relentless battle to replace the Affordable Care Act, efforts to drastically change that can spur a backlash.
The latest Republican proposal — by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana — was defeated in part because it would scrap the health law’s Medicaid expansion and reduce federal funding for Medicaid over time.
While Republicans in Congress are certain to continue to push for cuts, the fact is that Republican and Democratic governors as well as rich and poor Americans rely on the program.
Today, Medicaid is the nation’s largest health insurance program, covering 74 million, or more than one in five Americans. Twenty-five percent of Americans will be on Medicaid at some point in their lives — many are just a pink slip away from being eligible.
Medicaid funding protects families from having to sell a home or declare bankruptcy to pay for the care of a disabled child or elderly parent. It responds to cover disaster relief, public health emergencies and programs in schools that lack other sources of funding.
Millions of women who don’t qualify for full Medicaid benefits each year obtain family planning services paid for by Medicaid. These women have incomes as high as triple the federal poverty rate, or more than $36,000 for an individual. And thousands of women, who otherwise don’t qualify for the program, get treated each year for breast and cervical cancers through Medicaid.
“Instead of cutting Medicaid, (lawmakers) increased public awareness of its value and made it even harder to cut in the future,” said Jonathan Oberlan- der, professor of health policy and management at the University of North Carolina-Chapel Hill and a supporter of the federal health law. The Medicaid cuts passed the House, but the ACA overhaul fell short in the Senate in July.
Medicaid is the workhorse of the health system, covering:
❚ 39% of all children.
❚ Nearly half of all births in the country.
❚ 60% of nursing home and other long-term care expenses.
❚ More than one-quarter of all spending on mental health services and over a fifth of all spending on substance-abuse treatment.
Unlike Medicare beneficiaries, who keep that insurance for life, most Medicaid enrollees churn in and out of the program every few years, depending on their circumstances.
Such numbers underline the importance of Medicaid but also provoke alarm among conservatives and some economists who say the U.S. cannot afford the costs over the long run.
Bill Hammond, director of health policy of the fiscally conservative Empire Center for Public Policy in Albany, N.Y., said Medicaid has been a big help for those it was designed to cover — children and the disabled. But it has grown so big that the cost hurts state efforts to pay for other necessary public services, such as education and roads. “I can’t think of any other anti-poverty program that reaches so many people. … It’s too expensive a benefit.”
“We need to transition people to get coverage in the private sector,” he said, noting how millions on the program have incomes above the federal poverty level.
Joana Weaver, 49, of Salisbury, Md., who has cerebral palsy, has been on and off Medicaid since birth. For the past few years, it’s paid for home nursing services for six hours a day to help her get dressed, bathed and fed. That’s kept her out of a nursing home and enabled her to teach English part time at a local community college.
“For me, Medicaid has meant having my independence,” Weaver said.
Like Weaver, many people getting Medicaid today are not easily typecast. They include grandmothers — onequarter of Medicaid enrollees are elderly people or disabled adults — or the kid next door. About half of Medicaid enrollees are children, many with physical or mental disabilities.
Many of the rest — about 24 million enrollees — are adults younger than 65 without disabilities who earn too little to afford health insurance otherwise. About 60% of non-disabled adult enrollees have a job. Many of those who don’t work are caregivers.
“It’s the mechanic down the street, the woman waiting tables where you go for breakfast and people working at the grocery store,” said Sara Rosenbaum, a health policy expert at George Washington University in Washington, D.C.
While all states rely on Medicaid, it’s used more in some places than others because of varying state eligibility rules and poverty rates. As of August, about 44% of New Mexico residents are insured by Medicaid. In West Virginia and California, the rate is nearly one in three.
Jane and Fred Fergus, in Lawrence, Kan., said Medicaid has been a cornerstone in their lives since their son, Franklin, was born eight years ago with a severe genetic disability that left him unable to speak or walk. He is blind and deaf on one side of his body.
Although the family has insurance through Fred’s job as a high school history teacher, Franklin was eligible for Medicaid through an optional program that lets children be cared for at home, rather than moving to a hospital or nursing home.
Medicaid pays all his medical bills, including monthly transportation costs to Cincinnati Children’s Hospital, where for the past 18 months he has been receiving an experimental chemotherapy drug to help shrink tumors blocking his airway, Jane Fergus said. It also covers his wheelchair, walker and daily nursing care at home.
“We have such great health care for him because of Medicaid,” his mother said.
Medicaid serves as a backstop for America’s scattershot health care system, and as Republicans learned this year, efforts to change that can spur a backlash.