By Glenn Ellis
The current Senate proposed bill includes massive cuts to Medicaid, the government-run health program that provides insurance primarily to pregnant women, single parents, people with disabilities, and seniors with low incomes. The American Health Care Act (ACHA), the GOP leadership’s plan to repeal and replace the Affordable Care Act (ACA) is looming over us like a dark cloud, foretelling an impending storm.
Under the Affordable ACA, eligibility for Medicaid was expanded to include any adult living under 138 percent of the federal poverty level — an income of $27,821 for a family of three in 2016. It’s up to states to decide whether they want to participate. States that expanded Medicaid under the new ACA requirements received federal funds to do so.
Thirty-two states and the District of Columbia have chosen to participate so far, leading to more than 11 million new people nationwide gaining coverage, a number that continues to grow.
The Congressional Budget Office estimated in March that changes to eligibility under the AHCA would most likely result in a loss of 14 million people from the Medicaid rolls by 2026.
People often confuse Medicaid for Medicare, another popular government-sponsored program. However, these programs are very different in what they are designed to do.
Medicare is the national health care assistance program provided by the federal government. Its function is to make sure that affordable health care is available to all seniors and disabled people younger than 65.
Created in 1965, Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities; it is funded jointly by the federal government and the states. Each state operates its own Medicaid program within federal guidelines. Because the federal guidelines are broad, states have a great deal of flexibility in designing and administering their programs. As a result, Medicaid eligibility and benefits can and often do vary widely from state to state.
Medicaid is an “entitlement” program, which means that anyone who meets eligibility rules has a right to enroll in Medicaid coverage. It also means that states have guaranteed federal financial support for part of the cost of their Medicaid programs.
In 2015, Medicaid provided health coverage for 97 million low-income Americans over the course of the year. In any given month, Medicaid served 33 million children, 27 million adults (mostly in low-income working families), 6 million seniors, and 10 million persons with disabilities, according to Congressional Budget Office (CBO) estimates.
Children account for more than two-fifths of Medicaid enrollees but less than one-fifth of Medicaid spending. Only slightly more than one-fifth of Medicaid enrollees are seniors or persons with disabilities, but because they need more (and more costly) health care services, they account for nearly half of Medicaid spending.
Medicaid is a wonderful provision to make sure that those with few means receive the care they need even when they cannot afford to pay for it themselves. However, Medicaid does have its limitations, and one area that is draining Medicaid of its precious resources is long-term care.
Medicaid has greatly reduced the number of Americans without health insurance. Since health reform’s major coverage expansions took effect in 2014, Medicaid has helped to reduce the number of uninsured from 45 million to 29 million. If Medicaid did not exist, most of the tens of millions of Americans whose coverage comes solely through Medicaid would become uninsured. This is because private health insurance is generally not an option for Medicaid beneficiaries: many low-income workers do not have access to coverage through their jobs and cannot afford to purchase coverage in the individual insurance market.
About three-quarters of all Medicaid spending on services pays for acute-care services such as hospital care, physician services, and prescription drugs; the rest pays for nursing home and other long-term care services and supports. Medicaid covers more than 60 percent of all nursing home residents and 40 percent of costs for long-term care services and supports.
Medicaid also reimburses certain hospitals for the uncompensated costs they incur when they care for low-income uninsured patients. These payments, known as Disproportionate Share Hospital payments, account for about 3 percent of Medicaid services spending.
About 1.3 million people in the US are receiving treatment for substance-use disorders or mental illnesses thanks to the Medicaid expansion. If the AHCA does become law and the Medicaid expansion is phased out, then Ohio, Pennsylvania, and West Virginia, among other states suffering the brunt of the opioid crisis, would be ill-suited to handle the loss in funds.
Medicaid is the nation’s largest single health insurer, covering nearly one-fifth of all Americans. It insures two in five children and the same share of the disabled, as well as three in five nursing home residents. It pays for nearly half of all births and spending on long-term care in the U.S.
As you can see, Medicaid cuts won’t just hurt poor people…
Remember, I’m not a doctor. I just sound like one.
Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.
Glenn Ellis, is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and Information is the Best Medicine. For more good health information, visit: www.glennellis.com
