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Medicaid At 50: From Exclusion To Expansion To Universality


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Healh Affairs blog

Nov. 14, 2014

[h=2]Medicaid At 50: From Exclusion To Expansion To Universality[/h]

For almost five decades, Medicaid has been a safety net with gaping holes. Medicaid has provided invaluable health care access for the "deserving poor"--the impoverished blind, disabled, children, pregnant women, and elderly--but they only comprise approximately 40 percent of the nation's poor. The Patient Protection and Affordable Care Act (ACA), as part of its comprehensive insurance coverage architecture, rendered all Americans earning up to 138 percent of the federal poverty level (FPL) eligible for Medicaid. Through the effort to "provide everybody ... some basic security when it comes to their health care," the ACA adopted a universal approach to health care access. Universality is a fundamentally different philosophical approach in American health care, and an important progression away from the stigmatizing rhetoric of the "deserving poor." ...


Has 43 years experience.

I get the distinct impression that many voting Americans are quite comfortable with judging the "deserving" status of other citizens when it comes to social safety nets or other government programs. This is human nature really, and it is a topic of a Biblical parable (maybe more than one).

brandy1017, ASN, RN

Specializes in Critical Care.

The medicaid program is not all that great. Reimbursement rates are so low and decreasing in many places that it is hard to find a Dr willing to treat patients and almost impossible to get a dentist willing to see children on medicaid. If you are declared disabled by social security you still have to wait two years before you get insurance coverage thru medicare unless you are poor enough to go on medicaid. Think about your fellow coworkers who've needed to go on disability, esp due to work related back damage and they are not poor enough to get insurance and if they can't afford COBRA and most can't will find themselves without insurance at exactly the time they need it the most! Also if you have a home prepare to lose it if you end up on medicaid when you become poor. That is not the case with regular insurance or medicare! Lastly state medicaid programs have been cutting benefits such as Arizona refusing to offer transplants to patients on medicaid, allowing literally hundreds of people to die because they are living in the wrong state! Nothing has really been said about this in the media, ironically if an insurance company was denying care it would make headline news. Yet when state medicaid programs due the same, playing God, it's ok! It is not ok! Our health insurance in America is a total mess.