If you’ve opened up the newspaper or turned on the television lately, you’ve probably come across a story about “Medicare for All”. Proposals to expand the role of Medicare (America’s public health insurance program for people age 65 or older) have been introduced in Congress and have made their way into the stump speeches and campaign platforms of many of the 2020 Democratic candidates for President. But why has all the discussion centered on Medicare for all? What about its sister program, Medicaid?
President Lyndon B. Johnson signed both Medicare and Medicaid into law on July 30, 1965 as part of his “Great Society” movement that aimed to eliminate poverty. The two programs were both designed with the common goal of providing basic health insurance coverage for some of our most vulnerable Americans including the elderly (covered by Medicare) and pregnant women, children, individuals with low-incomes, and individuals with disabilities (covered by Medicaid).
To help us understand whether we should be talking about “Medicaid for all” alongside or instead of “Medicare for all,” let’s dig into some basic information about Medicaid.
So what is Medicaid? Medicaid is health insurance. Medicaid serves vulnerable low-income populations including individuals with disabilities and children in the foster care system. Medicaid also serves as a critical safety net, providing temporary help to individuals and families in crisis (e.g. after the loss of a job or a major accident).
Who gets Medicaid? Medicaid is a primary insurer of children facing adversity, as well as young children whose brains and bodies are rapidly developing. In Iowa, Medicaid covers:
Medicaid also provides health coverage to low-wage workers in jobs without benefits. Medicaid helps these folks—who fill needed roles in farming, construction, food service, home health care and child care.
Medicaid makes a difference for Iowa kids and families. When families have access to affordable health care through programs like Medicaid, they can get the care they need to ensure small health problems don’t become bigger issues. That means healthier more reliable workers who spend less time at the doctor’s office and miss fewer days of work due to illness.
Medicaid helps set kids on a path to be successful adults. Research shows that compared with their uninsured peers, children enrolled in Medicaid are more likely to 1) miss fewer days of school; 2) perform better in school; 3) graduate high school and go to college; 4) earn higher wages and become tax-paying adults. By covering important health services that set children on a path to healthy adulthood, Medicaid supports the long-term financial stability of our health care system.
In sum, Medicaid is a comprehensive health insurance program that provides high-quality health care to millions of Americans and thousands of Iowans. So why aren’t we talking about “Medicaid for all”? It comes down to perceptions of who is “deserving” and “undeserving” of health care. Policymakers have shied away from making any substantial changes to the Medicare program (in terms of scaling back benefits or reducing the eligibility standards) because the elderly are viewed, by and large, as “deserving” of the health care coverage they receive through the Medicare program. On the other hand, the Medicaid program has been under threat for years with proposals to reduce enrollment and scale back benefits repeatedly surfacing at both the state and federal levels. Medicaid has been a much more likely target for these cuts because the populations it covers (specifically low-income individuals) are often seen as “undeserving” of the health care coverage they receive through the Medicaid program. As a result, “Medicare for all” is seen as a more politically palatable vehicle to work towards universal health care coverage than “Medicaid for all”. But now that you know about all the great things Medicaid does, maybe you can help “flip the script” and lift up the important ways that Medicaid makes a difference.
We all want Iowa to be the healthiest state in the nation. Medicaid helps us make progress toward that goal. It makes it possible for thousands of low-income Iowa children and adults to get and stay healthy by allowing them to see a doctor when they are sick, get check-ups, buy medications, and go to the hospital without fear of choosing between their health and groceries or paying the rent or mortgage. Medicaid makes a difference for thousands of Iowans—our neighbors, friends, and family members. Medicaid makes a difference for Iowa. By committing to provide our children with high-quality health care when they need it, we give them a greater chance of succeeding in life—and the helps all of us everywhere.
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