May 2009 U.S. Poverty Action
Expanding and Strengthening Medicaid to Meet the Needs of Low-Income Americans
Medicaid is a program that pays for medical assistance for individuals and families with low incomes and resources. Medicaid is larger than any single private health insurer. To qualify for Medicaid, an individual must meet financial criteria and also be part of a group that is "categorically eligible" for the program, such as low-income children, pregnant women, the elderly, people with disabilities, and parents.
The income levels at which these groups qualify vary from state to state and group to group. Generally children and pregnant women at higher income levels are covered, followed by the disabled and elderly, then parents of dependent children. Childless adults who are not disabled or elderly rarely qualify for Medicaid even at the very lowest income levels.
Services covered by Medicaid include physician and hospital visits, well-child care, health screenings, vision care and dental services and all services that a doctor or other health care professional identifies as "medically necessary." A few key statistics on Medicaid:
Medicaid is a shared program between the federal and state governments and is countercyclical. As the economy worsens and more people lose their jobs and health benefits, many people turn to government safety net programs such as Medicaid, thus requiring an increase in funding for the program. Unfortunately, because Medicaid is a federal-state partnership and therefore funding for Medicaid is dependant on state budgets, states often cut Medicaid during economic downturns in order to balance their budgets. During this deepening economic crisis, we must make sure that these safety nets are protected, and expanded, to meet their growing demand. RESULTS was active in pushing for a boost in federal Medicaid funding as a part of the economic recovery package.
Medicaid Expansion Should be Included in Health Reform
In 2008 RESULTS endorsed a model of a National Health Program, through an expansion of Medicare, as our long-term goal for a health system, and we support the National Health Care Act (H.R.676) in the House and American Health Security Act of 2009 (S.703) in the Senate. During this year’s reform efforts, RESULTS will engage in the effort to strengthen the Medicaid program within the broader health reform debate. We will push to expand Medicaid eligibility to all those currently in poverty and near poverty, increase funding for Medicaid so that families do not lose coverage during economic downturns, and improve the payment structure to guarantee that Medicaid participants can access quality care in their communities.
Medicaid was designed to address the needs of low-income individuals; therefore, it is the best program in the short term to cover low-income uninsured Americans. Medicaid covers many services not typically covered by private health insurance such as:
Medicaid currently protects low-income individuals against unaffordable out-of-pocket costs. Federal policies limit how much a person on Medicaid can be charged for services, and adults enrolled in private insurance plans pay more than six times as much in out-of-pocket expenses. Those in Medicaid are less likely than those without insurance, and those in private insurance, to lack a usual source of coverage or to have unmet health care needs.
RESULTS is joining with our allies at Families USA, Georgetown University Health Policy Institute’s Center for Children and Families, the Center on Budget and Policy Priorities and elsewhere to urge Congress to address the growing health care needs of low-income individuals and families. Medicaid is the right foundation to cover a growing underserved population because it already does so efficiently for millions of Americans. Every state already has a Medicaid program and it would be easiest to build on in the short term. Medicaid also carries 20 percent fewer overhead and administrative costs than private insurance, creating a more efficient and cost-effective program.
RESULTS remains committed to H.R.676 and S.703 as marker bills for the health system our country needs. Unfortunately, the major players drafting health reform legislation in the House and Senate are not using a single payer system as the model for health reform legislation this year. In the meantime, the health of millions of low-income Americans is at stake, and our work to strengthen Medicaid (and community health centers, our April action) in 2009 will have a huge impact. We are supporting policies that are building blocks to a national health program and will make a huge difference to people living in poverty in the short term.