Navigating a pandemic and its impact on policy, operations, and service delivery is new territory for everyone in health care, including the Medicaid world. Among the many challenges that state Medicaid programs are navigating, the most substantial include managing budget shortfalls, transitioning to more robust telehealth systems, and supporting safety-net providers.
Because individuals with low incomes and communities of color are at the highest risk of serious illness from COVID-19, Medicaid will continue to play a central role in the pandemic response. Therefore, it seems fitting to acknowledge that the program passed a milestone last week: its 55th birthday. Signed into law on July 30, 1965 by President Lyndon B. Johnson, Medicaid has evolved over the decades, supporting millions of individuals over its 55-year history. Here are just a few reasons why our team at the Center for Health Care Strategies is celebrating Medicaid’s history and its vital role in the U.S. health care system:
- Long-term benefit to children: Over 35 million children receive their health coverage through Medicaid and the Children’s Health Insurance Program. The comprehensive benefit package that guarantees care for children — Early Periodic Screening, Diagnostic, and Treatment (EPSDT) — is perhaps one of the best benefit packages a parent or caregiver could ask for their children within our health care system. There is a body of research that highlights that Medicaid coverage for children contributes to long-term positive outcomes with respect to health, academic achievements, and economic success.
- High-quality and efficient care: There is a narrative that Medicaid is expensive and provides low-quality care. Research and data, however, indicate that Medicaid beneficiaries’ access to care is comparable with private insurance and is more cost efficient. Some states have considered using Medicaid as a public option or “buy-in” program, and some thought leaders have suggested that “Medicaid for More” is a better solution to our health care woes than “Medicare for All.”
- Bolsters economic participation: The majority of adults under 65 without disabilities enrolled in Medicaid work either full- or part-time, or are in school. Medicaid is also a support for workforce participation — many Medicaid-enrolled adults work in industries with low levels of employer-sponsored insurance. Without Medicaid, many individuals in our society would not otherwise have access to another source of health coverage. From a purely economic perspective, state Medicaid programs and the federal government collectively spend close to $600 billion annually, spurring economic activity across the country. For example, one analysis suggests that “the 90 cents received from the federal government for each dollar in Medicaid [expansion] spending translates to between $1.35 and $1.80 in state economic activity.”
- Offers policy levers to reduce health disparities: Medicaid covers a diverse population of more than 70 million Americans with a wide range of health care needs and representing a large number of racial and ethnic groups. Without Medicaid, many of these individuals would not have access to affordable coverage options. COVID-19 has exacerbated many long-standing health care inequities, which has further stimulated a renewed focus on health equity and increased attention to dismantling racist structures. Medicaid programs have an important platform and opportunity to push for long-term changes that reduce disparities and improve outcomes.
- The little program that could (and did, and does): Medicare was a central force of the Social Security Amendments of 1965, and it wasn’t until the end of negotiations that Medicaid was eventually added into the bill that ultimately created the “three-layer cake” of Medicare Part A and B, and Medicaid. Over the decades, Medicaid’s coverage and scope has been challenged repeatedly by lawmakers. Yet, it has survived political and legal challenges, which is indicative of its role in the U.S. health care system and the value of health care.
Working within Medicaid — whether at the federal, state, health plan, or community level — can be challenging. Medicaid can sometimes feel immovable, bureaucratic, and fraught with political challenges. Despite this, it is a remarkable program with a 55-year history of demonstrating a commitment to continuous innovation and dedicated to doing better for millions of people who might otherwise be forgotten by our health care system. Happy Birthday, Medicaid!