Medicaid Medicare What's Buzzing

Medicare and Medicaid at 50: Their roles in our health care system

Written by Diane Archer

A 2015 article in Health Affairs by Drew Altman and Bill Frist speaks to Medicare and Medicaid at 50, looking at the numbers, their roles in our health care system, the challenges they face and emerging issues. Medicare, a federal social insurance program, helps ensure older adults and people with disabilities have affordable access to the care they need. Medicaid, a joint state and federal program, covers older adults, people with disabilities and people with low incomes.

The Medicare and Medicaid numbers:

  • Collectively, they serve 111 million people, one in three Americans
  • By 2025, they will serve 139 million people
  • Ten million people have Medicare and Medicaid
  • They are responsible for $1 trillion in annual health spending, 39 percent of national health spending and 23 percent of the federal budget
  • They generate 43 percent of hospital revenues
  • Median income for people with Medicare is $23,500 and with Medicaid is $15,000

The emerging issues:

  • Will Medicare and Medicaid continue to be “open-ended” programs, with guaranteed benefits and no spending cap?
  • Will they become increasingly privatized? Today, less than a third of people with Medicare are in private Medicare Advantage plans, but the number could increase. And, more than half of people with Medicaid are in private managed care plans.
  • Will they shift more costs onto the people they serve?
  • Will they continue to play a role in reshaping delivery of care and reform of our health care system?

To date:

  • Expansion of Medicare and Medicaid eligibility and benefits; Medicare now covers people with disabilities and people with ALS and ESRD; Medicaid now covers people with incomes up to 138 percent of the federal poverty level in most states.
  • Stronger financial incentives to improve quality and efficiency
  • Polling data show both Medicare and Medicaid remain very popular. 72 percent of Americans have a favorable view of Medicare and 90 percent of adults 65 and older.

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  • I have a serious concern: although I paid into Medicare since its inception, I am ineligible for it because I live abroad. This is grossly unfair. I live in Cambodia — I moved here because I could no longer afford to live in the United States — and any private health and accident insurance is well beyond my means. I am now 75 years old and in good health. I suppose it is lobbying by the AMA, Big Pharma,the HMO’s, etc., that keeps this program restricted to those who live in the U.S. They want the MONEY. Indeed, Medicare would SAVE money by allowing expatriates to be treated abroad. I think that by now, everyone knows that the U.S. has the highest-cost medical care in the world. I’d appreciate a response.

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