July 30, 2018 is the 53rd anniversary of President Lyndon B. Johnson signing the bill that led to Medicare and Medicaid into law. This was part of Johnson’s social reform movement known as “The Great Society,” whose main goals were to eliminate poverty and racial injustice. The programs were intended to remove racial segregation practiced by hospitals and other health care facilities at the time.
At first Medicare covered fewer than 5 million people, but since 1965 it has expanded significantly. Thanks to the Affordable Care Act expanding Medicaid, Medicaid covers even more people. In 2015, one in three Americans was covered by Medicare or Medicaid.
In North Carolina, almost 2.3 million people receive comprehensive, affordable health coverage through Medicaid.
Here is some general information about the two programs, which many people confuse, and how it helps people in North Carolina.
Medicare is a federal program that provides health coverage if you are 65 and older or have a severe disability, no matter your income.
- Medicare serves as a crucial source of healthcare for seniors – especially women, who are 54% of recipients.
- Almost 20% of Medicare recipients are under age 65 – including surviving spouses and children.
Medicaid is a state and federal program that provides health coverage if you have a very low income.
- Medicaid is a lifeline to those poor, older, and disabled Americans that would not have access to healthcare without this vital program.
- Medicaid covers low income pregnant women, children and families.
- It should be expanded to cover those not covered by the ACA.
- Expanding Medicaid would get healthcare to cover more North Carolinians, and also would bring tens of thousands of jobs and billions of dollars of federal money into all counties of North Carolina.
The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance percentage (FMAP).
States can tailor their Medicaid programs to differently serve the people in their state, so there’s a wide variation in the services offered. “Medicaid policy and politics changed dramatically and unexpectedly in the late 1980s,” according to the chair of the department of health policy and management in Columbia University’s Mailman School of Public Health, Michael S. Sparer. Sparer thinks that expanding and building on Medicaid could become a bipartisan American version of affordable coverage for all.
Millions Depend On Medicaid and Medicare
In 2017, 58.5 million people were on Medicare Parts A and B, according to the Centers for Medicare & Medicaid Services.
In July of 2017, CNN reported “74 million people receive health coverage under Medicaid.”
“When Medicaid was signed into law in 1965, fewer than 5 million Americans qualified for benefits under this program. But a growing population and a number of changes to the law — the Affordable Care Act alone added 16.3 million enrollees — amplified the total number of beneficiaries.“
There is growing appreciation for Medicaid, and more Republican states have expanded Medicaid in 2018 – Virginia did it, Maine voters approved it (although the current governor is refusing to implement it), and there are ballot measures in Utah, Idaho and Nebraska for November 2018. Medicaid expansion may also become a big issue in some races in Florida, Georgia and Kansas. However, the future of Medicaid and Medicare are at risk under the Trump administration, which refers to them and other programs like Social Security and ACA as ‘entitlement programs’.
The Trump administration is fighting internally about what to do about the states who want to expand now. According to the New York Times, 7/30/18,
“Hoping to head off a full expansion of Medicaid under the Affordable Care Act, some senior officials in the Trump administration and Republican governors have been pushing hard for a smaller expansion to satisfy a growing political demand in their states. But President Trump decided on Friday to shut down the debate until after the midterm elections, administration officials said.”
In North Carolina, almost “2.3 million people receive comprehensive, affordable health coverage through Medicaid.” More North Carolina specific numbers in “Medicaid and Medicare mark 53rd anniversary by continuing to serve millions of North Carolinians today,” 7/31/18, NC Policy Watch.
The benefits of expanding Medicaid in North Carolina has always been a win/win/win for North Carolina which the NC General Assembly has been blocking since 2013. The NC Department of Health and Human Services recommends “expanding Medicaid to cover 670,000 additional individuals and secure North Carolina’s share of federal resources to inject over $4 billion in direct spending into the state.” Because of all the benefits, expanding Medicaid is part of Governor Cooper’s Budget Recommendations FY 2018-19.
More information on Medicaid and Medicare and current debates can be found in the following articles.
“Medicaid and Medicare mark 53rd anniversary by continuing to serve millions of North Carolinians today,” 7/31/18, NC Policy Watch.
“Governor Cooper’s Budget Recommendations FY 2018-19,” May 2018.
“Medicaid affects millions of Americans, young and old,” 7/13/17, CNN.com
“A Vote Expanded Medicaid in Maine. The Governor Is Ignoring It.” 7/24/18, New York Times.
“Trump Spurns Medicaid Proposal After Furious White House Debate,” 7/30/18, New York Times.