Brief history of Medicaid

Source - Economist, July 1, 2017: "Patching up the poor"     

Platform: Medicaid impacts about 100 million Americans every year. Cutting it is unpopular. 

Medicaid Enrollment

Part of the reason ACA repeal failed in the summer of 2017 was that the repeal bill contained a provision to cut Medicaid expenses by one-fourth by 2026. This attracted opposition from Republicans like Senator Susan Collins of Maine.

A brief history of Medicaid - law passed in 1965, creating a program where states decided upon eligibility standards and administered the program, while the federal government paid for half the expense. Initially designed for those already on welfare, the program also included coverage for the “medically needy” - a term left up to the states to define. Most states covered those on welfare or elderly in nursing homes but some like New York used a “medically needy” definition that covered half their population. Congress put limits on Medicaid expansion in 1976. By the 1980’s, Congress allowed states to cover children without means-testing their parents and required states to automatically cover poor women and their babies. Then in 2010, the ACA expanded Medicaid to include anyone earning less than 138% of the federal poverty line. Even though some states refuse the expansion, Medicaid still covers about 80 million people with yearly usage at about 100 million or about one in three Americans.

The GOP wants to means-test Medicaid recipients, removing coverage from what it calls “able-bodied adults”. Only about one-fourth of Medicaid spending goes to the able-bodied working poor. The other three-fourths is spent on the disabled, children and the elderly (two-thirds of all nursing home occupants are on Medicaid). Another Medicaid issue is that only 70% of doctors will accept new patients on Medicaid (versus 91% for private insurance).