Here is an article that stood out amid the tidal wave of media coverage of Medicare and Medicaid’s 50th anniversary this year. It’s a piece about why Medicaid matters, posted on the Health Affairs blog.
As you read, keep in mind that the article is written by two people who strongly support the program: former Denver Health Chief Executive Patricia Gabow, who serves on the Medicaid and CHIP Payment and Access Commission and on the National Governors’ Association Health Advisory Board, and former Senate Democratic Leader Tom Daschle. It is not, by and large, a critique.
Some of what they write is probably familiar to you, including the reminder that Medicaid is the largest health care program in the country. Much of the progress in bringing down infant mortality is because of Medicaid coverage of pregnant women. Children covered by Medicaid or CHIP are more likely to have a regular source of care.
Medicaid pays for more than 60 percent of long-term care. Medicaid supports safety net hospitals (which provide much of the country’s burn unit and trauma care) and community clinics. Medicaid is very – arguably, too – complex since it varies so much from state to state and has so many eligibility pathways , and – on the downside – many doctors still don’t take Medicaid, etc.
But this section is worth noting:
Medicaid covers people and care that private insurance would not and could not cover economically. An excellent example is coverage under Medicaid for disabled children. The program either completely covers the expensive costs for these children or wraps around private coverage that fails to do so.
In addition, Medicaid covers at least three quarters of all disabled adults on Supplemental Security Income. Patients with a disability make up 15 percent of Medicaid’s beneficiaries, but account for 40 percent of the cost. Thus, in recent years, the annual cost of care for disabled beneficiaries in the Medicaid program has exceeded $170 billion – costs not transferred to private markets or Medicare.
This value can also be demonstrated in some private insurance premium support models. In these models, high cost and medically frail patients can remain on Medicaid as it provides the necessary wrap around coverage for medical services that the private insurance does not provide.
Medicaid costs a lot and it’s reasonable for governors and state legislatures to be concerned. But when we health journalists and statehouse reporters write about Medicaid, and when we cover calls to “reform” it, or to have more “skin in the game” or to institute work requirements, we need to remember who Medicaid serves.
Many recipients are over 65 years old (Medicare-eligible, but poor enough to be “dual eligible” and so also receiving Medicaid) or they are disabled. Not all the state reform programs we hear about would apply to these more vulnerable and fragile populations, but we should write about who would and would not be affected, what it means, and where the projected “savings” would come from.