As Medicaid approaches two score and ten, we have a very heartfelt birthday greeting.
"This is to extend our very warm wishes to you for a wonderful birthday on July 29. And even better wishes to you for a long and healthy life. We all know that you have not really aged. You are even more attractive today than you were a quarter-century ago. In fact, you simply are magnetic.”
President Lyndon Johnson signed Medicaid into law on July 29, 1965. From his vantage point, he simply could not have envisioned the pervasive and critical role that Medicaid plays in every corner of American society today. Medicaid now touches directly the lives of one out of every four Americans.
The vision of a public health insurance system in America comes from the post-revolutionary period. As early as the founding of the United States of America in 1789, several of our Founders envisioned such a system. Both President John Adams and President Thomas Jefferson supported legislation that would have created a public health insurance system. More recently, in 1935, President Franklin Roosevelt envisioned such a system when he created Social Security. In 1945, President Harry Truman advocated for legislation that would have created Medicaid and Medicare. Ultimately, President Lyndon Johnson brought both to reality in 1965 as part of his Great Society Program.
In 2015, Medicaid and the Children’s Health Insurance Program (CHIP) cover more than 71 million Americans (see http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/ ). Almost 6.5 million of these persons are new enrollees in the state Medicaid Expansions being implemented under the Affordable Care Act (ACA). More than 29 million are children and adolescents enrolled in Medicaid or CHIP. The balance encompasses adults with disabilities, including those dually eligible for Medicaid and Medicare, mothers of enrolled children, and elderly persons. An estimated 5 million adult enrollees have a disability due to mental illness.
Medicaid also is essential for persons with intellectual and developmental disabilities (ID/DD). Medicaid is a primary funder of state and county ID/DD programs. Further, under the ACA, persons with substance use conditions again can be covered by Medicaid; previously, they were excluded from coverage after 1998.
It is very important to note that Medicaid is a joint federal-state program, while Medicare is entirely a federal program. Because of its joint federal-state nature, Medicaid varies from state to state in benefit structure, population overage, and degree of federal financial participation. For the latter, federal financial participation varies from 55% in more affluent states to 79% in the less affluent.
It also is very important to note that Medicaid was designed as a health insurance program for Americans who are poor. Prior to the ACA, Medicaid coverage included those with incomes up to 50% of the Federal Poverty Level (FPL) in some states and those with incomes up to 200% FPL in others. (Currently, 100% FPL is an income slightly more than $11 thousand per year.) The ACA seeks to extend Medicaid to all citizens up to 138% FPL. All 30 states and DC implementing the state Medicaid Expansions have accomplished that goal.