Sarah Kliff reports for Vox that Nevada is close to enacting a Medicaid for all law. The legislation recognizes that health care should be a right and would allow anyone in the state without health insurance to buy into Medicaid. Medicaid is a federal-state program currently only available to people with low incomes.
The Republican Governor of Nevada now needs to decide whether he will sign the Medicaid for all legislation. To be clear, even if Medicaid for all is enacted in Nevada, it will need approval from the U.S. Department of Health and Human Services to become effective, as it depends on a Medicaid waiver from the federal government. And, neither Secretary Tom Price nor President Trump appears to be a fan of Medicaid; indeed, Trump’s budget proposes slashing Medicaid significantly.
Congress, for its part, has been increasingly supportive of Medicare for all legislation; more than half of all House Democrats support John Conyers improved Medicare for All bill. And, a majority of Senators were prepared to support expanding Medicare to people 55 and older during the health care debate in 2009 until Senator Joe Lieberman of Connecticut withdrew his support for the proposal at the 11th hour.
Medicare for all has the advantage of federal government leverage to rein in prices, a very large pool of doctors and hospitals, and treating everyone, no matter which state they live in, equitably. Medicare also has staying power, with its own funding stream, less subject to political pressures than Medicaid. And, Medicare is transparent, giving people the ability to see what’s working and not, and government the ability to drive system change nationally.
Medicaid for all arguably would be less costly than Medicare for all, since Medicaid pays substantially lower rates than Medicare–two-thirds of Medicare’s rates nationally. But, for that reason, access to care can be a struggle for people with Medicaid in most parts of the country today. If everyone in Nevada were able to enroll in Medicaid, it is hard to imagine how they would all get care unless the state increased provider rates significantly.
In addition, Medicaid for all would be subject to the same political and financial pressures at the state level that has kept people in different states from having the same Medicaid benefits and prevented people in several states from benefiting from Medicaid expansion. Governors and state legislatures who do not support Medicaid or health care as a right would be unlikely to support Medicaid for all in their states. Moreover, Medicaid would be in the cross hairs each time people of different political persuasions moved in and out of state government.
That said, both Medicare and Medicaid have the advantage of being relatively efficient and innovating for the public good, unlike private health plans which, for the most part, keep their innovations proprietary; the ACA established a Center for Medicare and Medicaid Innovation to fund and evaluate more health care innovations.
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