The Importance of Medicaid

I recently finished reading John E. McDonough's book, Inside Health Care (University of California Press, 2011), which is a very useful explanation of the provisions of the Affordable Care Act.

He notes why Medicaid is important: “Medicaid and CHIP are the nation's key public health insurance programs for about sixty million low- and lower-income Americans.  While the programs cover approximately 15 percent of the U.S. population, Medicaid and CHIP cover more than 40 percent of lower-income Americans, 24 percent of African Americans, 23 percent of Hispanics, 53 percent of low-income children, and 41 percent of all U.S. births – as well as 20 percent of Americans living with severe disabilities, 44 percent of persons living with HIV/AIDS, and 65 percent of nursing home residents.” (p. 142)

About Medicaid and the health care legislation, McDonough writes: “In four weeks of Senate debate on the PPACA through December 2009, it is easy to find statements by Republican senators disparaging the Medicaid program.   Far more difficult is finding statements from Democratic senators either supporting or defending the program that provided health insurance protection - including the Children's Health Insurance Program (CHIP) – to an estimated 60.4 million Americans in 2010, now the nation's largest health insurance program (by contrast, Medicare had an estimated 46.8 million enrollees in 2010).  If the ACA is implemented as written, that number is projected to grow by 21.8 million to 82.2 million by 2019.  Through the ACA, Congress has enacted the most thorough revamping of Medicaid in its history, and there was no Democratic senator who articulated a vision – or even just an explanation – of what was being done and why.” (p. 141)

Of course, given the recent Supreme Court decision and the uncertainties of which political party (or parties) will control the Congress and the Executive Branch next year, we do not know how Medicaid will evolve.