Happy Birthday to Medicare & Medicaid!

This month marks a half-century of health care coverage for elderly, impoverished, and disabled Americans by Medicare & Medicaid.  The dream of covering all Americans with health insurance began more than a century ago with President Theodore Roosevelt in 1912 and was supported by presidential advocates along the way in F. D. Roosevelt, Harry Truman, and John F. Kennedy.  Partial realization of the dream came to fruition on July 30, 1965 when President Lyndon Johnson signed the bill enacting Medicare and Medicaid.[1]

HappyBirthdayMedicareMedicaid

Prior to 1965, poor and elderly people in America often had to forgo needed medical care because the price of services was beyond their means.  For five decades, MediCARE has insured health care access for seniors older than 65 years and people with disabilities – acknowledging the social covenant to care for our neighbors and families as they age or become infirm.

MediCAID is state/federal partnership that provides health care for low-income children, pregnant women, families, and people with certain disabilities.  It keeps expectant mothers and their children healthy and prepared for a productive life.  Medicaid helps families care for their loved ones with chronic health conditions and disabilities at home instead of in institutions.

Here is the current state of Medicaid enrollment in Florida:

Today, 2 of every 5 children (1.7 million) receive their health care through Medicaid and the companion Children’s Health Insurance Program (CHIP/Florida Kid Care).  One of every ten adults under 65 years old (1.2 million) participate in Medicaid.  More than 675,000 low-income seniors and disabled people with Medicare benefits are dually eligible for Medicaid services including long-term supports and nursing home care.[2]

With the broad participation and the long history of Medicaid, now is an excellent time to reflect on the health outcomes of Medicaid enrollees.

Health Outcomes for Children who Participate in Medicaid

For pregnant women and their babies, the short-term effect of coverage through Medicaid in the 1980’s and 90’s showed an 8.5 percent reduction in infant mortality and a 7.8 percent reduction in the incidence of low birth weight[3]. At the same time, the preventive services offered to children resulted in a 5.1% reduction in childhood deaths.[4]  Studies that are more recent demonstrate that children born to mothers who received prenatal care through Medicaid services sustained the positive health outcomes as they grew up with lower rates of obesity, encountered fewer hospitalizations, and had lower rates of diabetes and other metabolic disorders as adults.[5]

These health results translate to economic and social benefits.  The same children whose mothers participated in Medicaid services during their pregnancies completed more education and achieved higher earnings as adults.  The evidence demonstrates that early exposure to health insurance improves health, social, and financial conditions for individuals and populations.  Furthermore, these improvements reduce health and social inequities. [6]

How Do Adults Fare with Medicaid?

Recent studies about adults with coverage through Medicaid compared premature death rates in states that expanded Medicaid coverage to low income childless adults with states that did not expand coverage.  In states that expanded Medicaid, premature adult deaths decreased by more than 6 percent.  Death rates went up in states without Medicaid expansion.  Because the newly covered Medicaid enrollees in the studied population were disproportionately members of minority populations, the greatest reductions of risk for premature and preventable deaths affected minority populations that have a burden of health disparities.[7]  Rigorous research also tells us that covering adults with Medicaid improved enrollees’ mental health and economic security. [8]

The Future of Medicaid and Expansion

Now, under the Affordable Care Act, Medicaid now has the potential to reach 800,000 uninsured adults in Florida who earn less than roughly $16,000 a year.  If Florida were to accept the $67 billion enhanced matching Federal dollars (starting in 2016 at 100% federal contribution and gradually tapering to 90% federal/10% state), Florida could realize a healthier population with fewer health disparities and a stronger health care delivery work force.

Medicaid expansion would move us nearer to the dreams of Presidents Theodore Roosevelt, Franklin D. Roosevelt, Truman, Kennedy, and Johnson by offering means to coverage for all Americans, no matter their income level.  Providing the financial and health security of insurance coverage for all Floridians would improve the physical, mental, and economic health and bring us closer to social equity across our communities.  As Americans, we aspire to the ideals of equality and justice.  There is no greater justice than access to health and life- sustaining services. Medicaid expansion in Florida would make great strides to bringing that vision to reality.

So, Happy Birthday, Medicare and Medicaid. We look forward to another 50 years, and beyond, of quality healthcare coverage for all Americans!

Florida – Medicaid’s 50th from Georgetown CCF on Vimeo.

[1] Morone, J. A., Litman, T. J., & Robins, L. S. (2008). Health politics and Policy (4th ed.). Delmar Cengage Learning, Clifton Park, NY

[2] The Kaiser Family Foundation State Health Facts online at: http://kff.org/statedata/

[3] Center on Budget and Policy Priorities (2015) Policy basics: Introduction to Medicaid online at http://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid

[4] ibid

[5] Miller, Sarah Marie and Wherry, Laura R., The Long-Term Health Effects of Early Life Medicaid Coverage (February 2, 2015). Available at SSRN: http://ssrn.com/abstract=2466691 or http://dx.doi.org/10.2139/ssrn.2466691

[6] O’Brien, R. L., & Robertson, C. L. (2015). Medicaid and Intergenerational Economic Mobility [IRP Discussion Paper No. 1428-15]. Retrieved from Institute for Research on Poverty website: http://www.irp.wisc.edu/publications/dps/dplist.htm

[7] Sommers, B.D.,Baicker, K., & Epstein, A.M. (2012). Mortality and access to care among adults after state Medicaid expansions. The New England Journal of Medicine (357) 1025-1034. Doi: 10.1056/NEJMsa1202099

[8] Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., . . . Finkelstein, A. N. (2013). The Oregon experiment — effects of Medicaid on clinical outcomes. New England Journal of Medicine, 368(18), 1713-1722. doi:10.1056/NEJMsa1212321